{ "hospital_name": "Garden Grove Hospital Medical Center", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Garden Grove Hospital Medical Center" ], "hospital_address": [ "12601 Garden Grove Boulevard Garden Grove, CA 92843" ], "license_information": { "license_number": "262583411", "state": "CA" }, "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": "Dan Brothman" }, "type_2_npi": [ "1659538858", "1003688953" ], "standard_charge_information": [ { "description": "ABDOMINAL PAIN - SOI : 2", "code_information": [ { "code": "2512", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5154.21, "maximum": 5515, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5154.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5515, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 3", "code_information": [ { "code": "2513", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6680.75, "maximum": 7148.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6680.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7148.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 1", "code_information": [ { "code": "2511", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3970.07, "maximum": 4247.97, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3970.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4247.97, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 4", "code_information": [ { "code": "1934", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18754.23, "maximum": 20067.03, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18754.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20067.03, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9842, "minimum": 8369.0301, "maximum": 19933.5714, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11455.88 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9940.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12794.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17833.74, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14369.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13837.88, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10432.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 15255.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 15255.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15747.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10110.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9842.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19933.57 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 1", "code_information": [ { "code": "5431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4539.67, "maximum": 4857.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4539.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4857.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABDOMINAL PAIN - SOI : 4", "code_information": [ { "code": "2514", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10145.16, "maximum": 10855.32, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10145.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10855.32, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11349, "minimum": 5718.58, "maximum": 21549.0058, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18376.47 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11349.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11463.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14754.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20565.58, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16570.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15957.62, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11349.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12030.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11349.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11349.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17591.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17591.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18159.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5718.58 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11349.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21549.01 } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 3", "code_information": [ { "code": "5433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9671.72, "maximum": 10348.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9671.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10348.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 2", "code_information": [ { "code": "5432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5975.15, "maximum": 6393.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5975.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6393.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 2", "code_information": [ { "code": "5642", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3745.55, "maximum": 4007.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3745.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4007.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITHOUT CCMCC", "code_information": [ { "code": "122", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7805, "minimum": 3667.09, "maximum": 14144.2002, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10678.49 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7883.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10147.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14144.2, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11396.54, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10975.03, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8274.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12099.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12099.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12489.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3667.09 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7805.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12565.93 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2923.44, "maximum": 3128.08, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2923.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3128.08, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY- SOI : 4", "code_information": [ { "code": "5434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17669.85, "maximum": 18906.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17669.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18906.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 1", "code_information": [ { "code": "1901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6639.41, "maximum": 7104.17, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6639.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7104.17, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 4", "code_information": [ { "code": "5644", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14390.43, "maximum": 15397.76, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14390.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15397.76, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8326, "minimum": 5433.12, "maximum": 31383.5433, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14188.26 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8410.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10824.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15088.27, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12157.22, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11707.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8826.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12906.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12906.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13322.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5433.12 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8326.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17317.75 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9057, "minimum": 9057.22, "maximum": 17076.9202, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13095.31 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9147.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11774.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16411.68, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13223.54, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12734.45, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9600.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14038.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14038.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14491.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12164.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9057.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17076.92 } ] } ] }, { "description": "ABORTION WO D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY - SOI : 3", "code_information": [ { "code": "5643", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6403.11, "maximum": 6851.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6403.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6851.33, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 1", "code_information": [ { "code": "1931", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8140.51, "maximum": 8710.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8140.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8710.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 3", "code_information": [ { "code": "1933", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13200.37, "maximum": 14124.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13200.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14124.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 1", "code_information": [ { "code": "7561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3331.89, "maximum": 3565.12, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3331.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3565.12, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE & SUBACUTE ENDOCARDITIS - SOI : 2", "code_information": [ { "code": "1932", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9819.71, "maximum": 10507.09, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9819.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10507.09, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 1", "code_information": [ { "code": "4011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10090.03, "maximum": 10796.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10090.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10796.33, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC", "code_information": [ { "code": "288", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25833, "minimum": 21819.3027, "maximum": 50602.742, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 36322.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 25833.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 27383.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 25833.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25833.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 40042.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 40042.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 41334, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35415.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50602.74 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37191.84 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 25833.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 26092.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25833.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33583.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 46810.76, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 37717.28, "additional_payer_notes": "146.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 3", "code_information": [ { "code": "1453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6782.52, "maximum": 7257.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6782.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7257.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9443, "minimum": 5936, "maximum": 17758.6632, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13691.99 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9537.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12275.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17110.81, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13786.85, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13276.93, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10009.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14636.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14636.73, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15108.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7780.72 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9443.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17758.66 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 2", "code_information": [ { "code": "4012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13076.33, "maximum": 13991.67, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13076.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13991.67, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CCMCC", "code_information": [ { "code": "290", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9156, "minimum": 9156.73, "maximum": 18136.5859, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15563.78 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9248.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11903.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16591.99, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13368.83, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12874.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9706.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14192.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14192.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14650.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12871.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9156.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18136.59 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 3", "code_information": [ { "code": "4693", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8886.82, "maximum": 9508.9, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8886.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9508.9, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16452, "minimum": 9121.53, "maximum": 29812.383, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21194.9 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16452.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16617.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21388.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29812.38, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24021.02, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 23132.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16452.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17439.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16452.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16452.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 25501.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 25501.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 26324.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9121.53 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16452.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29209.35 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7975, "minimum": 7975.77, "maximum": 18213.2184, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11190.54 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8055.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10368.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14452.1, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11644.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11213.93, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8454.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12362.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12362.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12761.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11833.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7975.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15146.55 } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 4", "code_information": [ { "code": "7564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10975.22, "maximum": 11743.49, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10975.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11743.49, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 4", "code_information": [ { "code": "4694", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17070.79, "maximum": 18265.75, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17070.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18265.75, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 2", "code_information": [ { "code": "7562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4969.75, "maximum": 5317.63, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4969.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5317.63, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43258, "minimum": 19350, "maximum": 90531.0194, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 64248.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 90531.02 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64994.64 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 43258.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 43691.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56236.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 78385.25, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 63158.1, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 60822.11, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 43258.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45854.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 43258.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43258.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 67051.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 67051.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 69214.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 43259, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43258.97, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 2", "code_information": [ { "code": "1452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4873.28, "maximum": 5214.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4873.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5214.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15211.37, "maximum": 16276.17, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15211.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16276.17, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE ANXIETY & DELIRIUM STATES - SOI : 3", "code_information": [ { "code": "7563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7029.52, "maximum": 7521.59, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7029.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7521.59, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6901", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8594.23, "maximum": 9195.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8594.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9195.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25746.65, "maximum": 27548.92, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25746.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27548.92, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 1", "code_information": [ { "code": "1451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3855.58, "maximum": 4125.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3855.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4125.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 1", "code_information": [ { "code": "7721", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3856.64, "maximum": 4126.6, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3856.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4126.6, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 3", "code_information": [ { "code": "1903", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9493.2, "maximum": 10157.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9493.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10157.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20009, "minimum": 15588.8685, "maximum": 39568.8803, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32064.16 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20209.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26012.61, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36257.58, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29214.16, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28133.64, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21210.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31015.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31015.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32015.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23902.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20009.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39568.88 } ] } ] }, { "description": "ACUTE BRONCHITIS AND RELATED SYMPTOMS - SOI : 4", "code_information": [ { "code": "1454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10920.09, "maximum": 11684.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10920.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11684.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7753", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8305.88, "maximum": 8887.29, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8305.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8887.29, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 4", "code_information": [ { "code": "1904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15137.17, "maximum": 16196.77, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15137.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16196.77, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51965, "minimum": 26662.7814, "maximum": 107864, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 80307.41 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 51965.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 52485.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 67555.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 94162.3, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 75870.29, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 73064.13, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 51965.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 55083.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 51965.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51965.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 80547.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 80547.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 83145.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 107864 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 51965.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 102396.68 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 1", "code_information": [ { "code": "4691", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4013.54, "maximum": 4294.49, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4013.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4294.49, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7754", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19303.36, "maximum": 20654.6, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 19303.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20654.6, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15487, "minimum": 11748.8553, "maximum": 30407.9592, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22755.43 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15487.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15642.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20134.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28063.73, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22612.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21775.72, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15487.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16416.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15487.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15487.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24005.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24005.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24780.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18044.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30407.96 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11877, "minimum": 10800, "maximum": 61413.3669, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20251.12 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11877.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11995.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15440.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21521.56, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17340.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16699.4, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11877.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12589.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11877.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11877.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 18409.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 18409.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19003.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16706.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11877.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23540.51 } ] } ] }, { "description": "ACUTE KIDNEY INJURY - SOI : 2", "code_information": [ { "code": "4692", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5463.76, "maximum": 5846.22, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5463.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5846.22, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA", "code_information": [ { "code": "894", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6220, "minimum": 4452, "maximum": 11561.8419, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8240.15 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6282.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8086.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11271.17, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9081.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8745.73, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6593.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9641.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9641.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 9952.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4569.65 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6220.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11561.84 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 1", "code_information": [ { "code": "7551", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2180.63, "maximum": 2333.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2180.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2333.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH MCC", "code_information": [ { "code": "283", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19024, "minimum": 8848.3926, "maximum": 36225.0052, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28276.12 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19024.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19214.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24731.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34471.51, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27775.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26747.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19024.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20165.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19024.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19024.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29487.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29487.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30438.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19024.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33493 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19024, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36225.01 } ] } ] }, { "description": "ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6904", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45078.63, "maximum": 48234.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 45078.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48234.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 3", "code_information": [ { "code": "2803", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9753.98, "maximum": 10436.76, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9753.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10436.76, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 4", "code_information": [ { "code": "7554", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8638.75, "maximum": 9243.46, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8638.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9243.46, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION - SOI : 2", "code_information": [ { "code": "1902", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7316.81, "maximum": 7828.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7316.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7828.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 2", "code_information": [ { "code": "8112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4082.45, "maximum": 4368.22, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4082.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4368.22, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13565, "minimum": 6750, "maximum": 44579.4342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21100.24 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13565.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13700.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17634.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24580.02, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19805.09, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19072.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13565.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14379.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13565.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13565.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21025.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21025.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21704.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19528.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13565.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26547.22 } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 2", "code_information": [ { "code": "7552", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2936.48, "maximum": 3142.03, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2936.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3142.03, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7217, "minimum": 7217.25, "maximum": 25320.5664, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10299.83 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7289.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9382.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13077.66, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10537.19, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10147.45, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7650.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11186.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11186.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11547.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10911.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7217.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13432.93 } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16215, "minimum": 8517.3129, "maximum": 32195.6819, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25444.78 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16215.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16377.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21079.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29382.01, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23674.25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22798.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16215.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17188.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16215.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16215.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 25133.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 25133.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25944.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18238.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16215.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32195.68 } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11597, "minimum": 8023.8891, "maximum": 29218.3, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18555.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29218.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19989.15 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15387.35 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11597.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11713.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15076.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21014.65, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16932.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16306.07, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11597.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12293.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11597.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11597.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11597.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17976.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17976.11, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 34395, "minimum": 18450, "maximum": 78339.3372, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50690.19 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 34395.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 34739.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 44713.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 62324.14, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 50217.02, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 48359.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 34395.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 36458.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 34395.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34395.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 53312.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 53312.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 55032.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46899.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 34395.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66084.61 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6927, "minimum": 6927.18, "maximum": 13727.4874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10609.65 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6996.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9005.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12552.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10113.68, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9739.62, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7342.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10737.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10737.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11083.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9742.18 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6927.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13727.49 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 4", "code_information": [ { "code": "0074", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 149835.59, "maximum": 160324.08, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 149835.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 160324.08, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11000, "minimum": 10276.2537, "maximum": 21095.128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16237.9 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11000.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11110.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14300.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19932.82, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16060.66, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15466.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11000.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11660.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11000.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11000.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17050.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17050.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17600.72, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18474 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11000.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21095.13 } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 4", "code_information": [ { "code": "7724", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18947.17, "maximum": 20273.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18947.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20273.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITHOUT CCMCC", "code_information": [ { "code": "285", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6051, "minimum": 5850, "maximum": 28286.2224, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7009.51 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6111.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7866.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 10964.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8834.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8508.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6414.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9379.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9379.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 9682.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7381.56 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6051.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10400.29 } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17935, "minimum": 14394.9363, "maximum": 34389.1158, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26542.03 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17935.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18115.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23316.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32500.01, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26186.55, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25218, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17935.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19012.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17935.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17935.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27800.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27800.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28697.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17935.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24405.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17936, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34389.12 } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7752", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4746.07, "maximum": 5078.29, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4746.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5078.29, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADJUSTMENT DISORDERS & NEUROSES EXCEPT DEPRESSIVE DIAGNOSES - SOI : 3", "code_information": [ { "code": "7553", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5442.55, "maximum": 5823.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5442.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5823.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 2", "code_information": [ { "code": "7722", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4532.99, "maximum": 4850.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4532.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4850.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC", "code_information": [ { "code": "896", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16811, "minimum": 10176, "maximum": 32990.4312, "payers_information": [ { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16811.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16811.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 26057.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 26057.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 26898.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13885.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32990.43 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25503.59 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16811.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16979.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21854.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 30462.17, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24544.57, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 23636.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16811.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16811.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17819.98, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21004, "minimum": 12150, "maximum": 42219.8971, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32306.56 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 21004.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 21214.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27306.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 38060.66, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30666.98, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 29532.72, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 21004.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22265.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 21004.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21004.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 32557.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 32557.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 33607.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32201.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21004.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42219.9 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 1", "code_information": [ { "code": "0521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4892.36, "maximum": 5234.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4892.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5234.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY", "code_information": [ { "code": "895", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13718, "minimum": 8717.62, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23075.29 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13718.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13855.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17833.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24857.29, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20028.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19287.72, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13718.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14541.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13718.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13718.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21263.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21263.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21949.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8717.62 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13718.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26823.25 } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8716, "minimum": 6996, "maximum": 16343.3055, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12272.01 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8803.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11331.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15794.21, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12726.02, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12255.33, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9239.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13510.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13510.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13946.32, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8716.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16343.31 } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 3", "code_information": [ { "code": "4013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24086.53, "maximum": 25772.59, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 24086.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25772.59, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 1", "code_information": [ { "code": "2801", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4881.76, "maximum": 5223.48, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4881.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5223.48, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 2", "code_information": [ { "code": "2802", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6415.73, "maximum": 6864.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6415.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6864.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADRENAL PROCEDURES - SOI : 4", "code_information": [ { "code": "4014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 45294.89, "maximum": 48465.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 45294.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48465.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOLIC LIVER DISEASE - SOI : 4", "code_information": [ { "code": "2804", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19238.69, "maximum": 20585.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 19238.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20585.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 4", "code_information": [ { "code": "8114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15162.61, "maximum": 16223.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15162.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16223.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFTERCARE WITHOUT CCMCC", "code_information": [ { "code": "950", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6321, "minimum": 6321.68, "maximum": 23326.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9159.55 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6384.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8218.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11454.88, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9229.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8888.28, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6700.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9798.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9798.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10114.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23326.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6321.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10857.87 } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 1", "code_information": [ { "code": "8111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2829.41, "maximum": 3027.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2829.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3027.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 2", "code_information": [ { "code": "0072", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66446.01, "maximum": 71097.23, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 66446.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 71097.23, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS - SOI : 3", "code_information": [ { "code": "8113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8023.9, "maximum": 8585.57, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8023.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8585.57, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL & DRUG DEPENDENCE W REHAB OR REHABDETOX THERAPY - SOI : 3", "code_information": [ { "code": "7723", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6860.97, "maximum": 7341.24, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6860.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7341.24, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 3", "code_information": [ { "code": "0073", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 89273.14, "maximum": 95522.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 89273.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 95522.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 2", "code_information": [ { "code": "0522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6485.69, "maximum": 6939.69, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6485.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6939.69, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7751", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3288.43, "maximum": 3518.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3288.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3518.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "475", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21792, "minimum": 21792.4, "maximum": 39965.3287, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30761.79 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 22010.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28330.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 39487.83, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 31816.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 30640.11, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23099.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 33778.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 33778.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 34867.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24765.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21792.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39965.33 } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6684, "minimum": 5231.77, "maximum": 20048.8572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9449.28 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6750.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8689.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12111.48, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9758.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9397.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7085.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10360.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10360.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10694.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5231.77 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6684.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12302.87 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11508, "minimum": 10191.1, "maximum": 21547.1533, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16880.47 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11508.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11623.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14960.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20853.06, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16802.13, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16180.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11508.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12198.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11508.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11508.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18413.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10191.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11508.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21547.15 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 113248, "minimum": 113248, "maximum": 242719.0205, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 164385.63 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 113248.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 114380.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 147222.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 205205.47, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 165342.15, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 159226.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 113248.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 120042.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 113248.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 113248.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 175534.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 175534.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 181196.88, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 113248.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 139118 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 113248, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 242719.02 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 1", "code_information": [ { "code": "3051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9407.33, "maximum": 10065.84, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9407.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10065.84, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC", "code_information": [ { "code": "617", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17986, "minimum": 17986.68, "maximum": 35784.0953, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28464.02 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17986.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18166.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23382.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32591.86, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26260.55, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25289.27, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17986.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19065.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17986.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17986.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27879.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27879.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28778.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18005 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17986.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35784.1 } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT- SOI : 1", "code_information": [ { "code": "0071", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55309.66, "maximum": 59181.34, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 55309.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 59181.34, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 4", "code_information": [ { "code": "3054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31219.94, "maximum": 33405.34, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 31219.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33405.34, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 4", "code_information": [ { "code": "2264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21704.49, "maximum": 23223.8, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21704.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23223.8, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 3", "code_information": [ { "code": "0523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9100.96, "maximum": 9738.03, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9100.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9738.03, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC", "code_information": [ { "code": "616", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33167, "minimum": 23908.0449, "maximum": 71601.5368, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 51409.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 53067.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29082 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 71601.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56765.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 33167.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 33498.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43117.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 60099.2, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 48424.3, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 46633.27, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 33167.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35157.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 33167.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33167.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33167.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 51409.36, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12715, "minimum": 12715.56, "maximum": 31853.9577, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18666.2 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12715.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12842.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16530.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23040.59, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18564.72, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17878.08, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12715.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13478.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12715.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12715.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19709.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19709.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20344.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15916.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12715.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23321.91 } ] } ] }, { "description": "ALTERATION IN CONSCIOUSNESS - SOI : 4", "code_information": [ { "code": "0524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15262.26, "maximum": 16330.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15262.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16330.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 1", "code_information": [ { "code": "2261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6668.03, "maximum": 7134.79, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6668.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7134.79, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 2", "code_information": [ { "code": "1982", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4834.06, "maximum": 5172.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4834.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5172.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANES 1ST 60 MIN", "code_information": [ { "code": "Z7506", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3450, "minimum": 146.17, "maximum": 3450, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 156.4 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] }, { "setting": "outpatient", "gross_charge": 3450, "minimum": 146.17, "maximum": 3450, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 156.4 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 3", "code_information": [ { "code": "0593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10738.81, "maximum": 11490.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10738.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11490.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 2", "code_information": [ { "code": "0592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7339.07, "maximum": 7852.8, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7339.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7852.8, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "474", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40729, "minimum": 40729, "maximum": 83081.866, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61715.78 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 40729.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 41136.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52947.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 73800.98, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59464.37, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 57265, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 40729.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43172.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 40729.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 40729.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 63129.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 63129.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 65166.43, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40729.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 68324.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 40729, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 83081.87 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5472", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8566.24, "maximum": 9165.88, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8566.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9165.88, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 4", "code_information": [ { "code": "0594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16561.94, "maximum": 17721.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16561.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17721.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 2", "code_information": [ { "code": "3052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12581.27, "maximum": 13461.96, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12581.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13461.96, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5474", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25639.21, "maximum": 27433.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25639.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27433.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC", "code_information": [ { "code": "240", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 27188, "minimum": 17696.7852, "maximum": 53950.3222, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40292.83 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 27188.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 27460.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 35344.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 49265.34, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 39695.03, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 38226.86, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 27188.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 28819.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 27188.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27188.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 42141.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 42141.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 43501.41, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24684.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 27188.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53950.32 } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5473", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13219.02, "maximum": 14144.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13219.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14144.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 2", "code_information": [ { "code": "2262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8216.84, "maximum": 8792.02, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8216.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8792.02, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 2", "code_information": [ { "code": "5662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3248.78, "maximum": 3476.19, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3248.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3476.19, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC", "code_information": [ { "code": "239", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 46631, "minimum": 36437.9415, "maximum": 93311.7155, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68944.75 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 46631.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 47098.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 60621.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 84497.06, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 68082.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 65564.49, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 46631.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 49429.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 46631.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 46631.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 72279.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 72279.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 74611.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46873.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 46631.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 93311.72 } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2268.08, "maximum": 2426.85, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2268.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2426.85, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND PERINEAL PROCEDURES- SOI : 3", "code_information": [ { "code": "2263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12875.97, "maximum": 13777.29, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12875.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13777.29, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 3", "code_information": [ { "code": "5663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6022.96, "maximum": 6444.57, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6022.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6444.57, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CCMCC", "code_information": [ { "code": "241", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13425, "minimum": 13425.26, "maximum": 40813.5624, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19994.38 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13425.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13559.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17452.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24326.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19600.88, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18875.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13425.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14230.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13425.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13425.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 20809.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 20809.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21480.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19851.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13425.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27971.84 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8601, "minimum": 7650, "maximum": 19487.6835, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13996.06 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8687.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11182.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15586.68, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12558.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12094.3, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9118.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13332.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13332.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13763.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8741.31 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8601.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16319.22 } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 40074, "minimum": 6750, "maximum": 77079.5638, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59647.5 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 40074.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 40475.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 52097.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 72615.37, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58509.08, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 56345.04, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 40074.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 42479.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 40074.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 40074.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 62115.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 62115.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 64119.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8124.21 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 40074.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77079.56 } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB EXCEPT TOES - SOI : 3", "code_information": [ { "code": "3053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18500.87, "maximum": 19795.93, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18500.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19795.93, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2331", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8727.8, "maximum": 9338.75, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8727.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9338.75, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 1", "code_information": [ { "code": "1981", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3984.92, "maximum": 4263.86, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3984.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4263.86, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2333", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15997.97, "maximum": 17117.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15997.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17117.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "618", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13743, "minimum": 13743.49, "maximum": 36909.6342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16659.59 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13743.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13880.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17866.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24903.2, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20065.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19323.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13743.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14568.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13743.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13743.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21302.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21302.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21989.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16370.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13743.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23066.25 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2332", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11244.48, "maximum": 12031.59, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11244.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12031.59, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 4", "code_information": [ { "code": "1984", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10894.65, "maximum": 11657.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10894.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11657.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2344", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21609.08, "maximum": 23121.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21609.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23121.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21979, "minimum": 11128.8798, "maximum": 43846.4469, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36562.17 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 21979.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 22198.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28572.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 39826.35, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32089.66, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 30902.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 21979.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23297.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 21979.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21979.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 34067.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 34067.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 35166.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31117 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21979.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43846.45 } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 3", "code_information": [ { "code": "2343", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13392.24, "maximum": 14329.7, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13392.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14329.7, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13392.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC", "code_information": [ { "code": "268", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 64995, "minimum": 17872.3, "maximum": 123521.4506, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 98318.12 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 65645.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 84494.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 117772.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 94894.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 91384.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 68895.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 100743.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 100743.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 103993.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17872.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 64995.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 123521.45 } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22911, "minimum": 22911.4, "maximum": 45902.7911, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32223.36 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23140.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29784.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 41515.46, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33450.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 32213.43, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24286.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 35512.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 35512.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 36658.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34450 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22911.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45902.79 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7018, "minimum": 7018.24, "maximum": 26655.1116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10012.97 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7088.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9123.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12717.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10246.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9867.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7439.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10878.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11229.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7819.81 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7018.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12936.44 } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 2", "code_information": [ { "code": "2342", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9012.97, "maximum": 9643.88, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9012.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9643.88, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASTHMA - SOI : 1", "code_information": [ { "code": "1411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3243.91, "maximum": 3470.98, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3243.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3470.98, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3243.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3243.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGINA PECTORIS & CORONARY ATHEROSCLEROSIS - SOI : 3", "code_information": [ { "code": "1983", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6257.77, "maximum": 6695.81, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6257.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6695.81, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASTHMA - SOI : 2", "code_information": [ { "code": "1412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4806.49, "maximum": 5142.94, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4806.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5142.94, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4806.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4806.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11175, "minimum": 8550, "maximum": 20819.0963, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15965.39 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11175.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11286.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14527.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20249.19, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16315.57, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15712.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11175.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11845.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11175.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11175.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17321.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17321.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17880.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11175.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19925 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11175, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20819.1 } ] } ] }, { "description": "ANOXIC & OTHER SEVERE BRAIN DAMAGE - SOI : 1", "code_information": [ { "code": "0591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4225.56, "maximum": 4521.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4225.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4521.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 2", "code_information": [ { "code": "0082", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 34562.44, "maximum": 36981.81, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 34562.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36981.81, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34562.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34562.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ASTHMA - SOI : 3", "code_information": [ { "code": "1413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6672.27, "maximum": 7139.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6672.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7139.33, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 3", "code_information": [ { "code": "0083", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 42705.07, "maximum": 45694.42, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 42705.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45694.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTEPARTUM WITH O.R. PROCEDURE- SOI : 1", "code_information": [ { "code": "5471", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4360.09, "maximum": 4665.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4360.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4665.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CCMCC", "code_information": [ { "code": "017", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51425, "minimum": 51425.2, "maximum": 111818.8139, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88597.75 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 51425.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 51939.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 66852.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 93182.5, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 75080.82, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 72303.86, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 51425.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 54510.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 51425.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51425.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 79709.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 79709.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 82280.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 79356.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 51425.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 111818.81 } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6748, "minimum": 6171.04, "maximum": 20143.4514, "payers_information": [ { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8773.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12228.84, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9853.26, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9488.83, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7153.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10460.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10460.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10798.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6171.04 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12456.63 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9439.23 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6748.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6816.3, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "ANTEPARTUM WITHOUT O.R. PROCEDURE- SOI : 4", "code_information": [ { "code": "5664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13254.22, "maximum": 14182.02, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13254.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14182.02, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 1", "code_information": [ { "code": "0081", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29173.95, "maximum": 31216.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 29173.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31216.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29173.95, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29173.95, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14453, "minimum": 9000, "maximum": 36689.7666, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20532.24 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14597.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18789.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26189.2, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21101.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20321.2, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15320.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 22402.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 22402.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23125.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20679.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14453.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26550.92 } ] } ] }, { "description": "APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS - SOI : 4", "code_information": [ { "code": "2334", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24117.27, "maximum": 25805.48, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 24117.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25805.48, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24117.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 2", "code_information": [ { "code": "0492", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11038.82, "maximum": 11811.54, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11038.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11811.54, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11038.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11038.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS - SOI : 1", "code_information": [ { "code": "2341", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7065.57, "maximum": 7560.16, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7065.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7560.16, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 2", "code_information": [ { "code": "7582", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4174.67, "maximum": 4466.9, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4174.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4466.9, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4174.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4174.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14638, "minimum": 13500, "maximum": 30977.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21705.52 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 14638.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14784.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19029.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26524.29, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21371.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20581.21, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 14638.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15516.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 14638.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14638.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 22689.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 22689.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23421.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30977.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14638.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28032.97 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 1", "code_information": [ { "code": "0491", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8313.3, "maximum": 8895.23, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8313.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8895.23, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8313.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8313.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 3", "code_information": [ { "code": "7583", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6793.12, "maximum": 7268.64, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6793.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7268.64, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6793.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6793.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHROSCOPY", "code_information": [ { "code": "509", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18000, "maximum": 38611.0515, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19594.2 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23095.8 }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32543.96 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC", "code_information": [ { "code": "519", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19206, "minimum": 14400, "maximum": 36530.678, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28235.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19206.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19398.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24967.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34801.51, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28040.95, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27003.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19206.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20358.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19206.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19206.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29769.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29769.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30729.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26395.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19206.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36530.68 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 4", "code_information": [ { "code": "0494", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25716.97, "maximum": 27517.16, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25716.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27517.16, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "409", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20868, "minimum": 20700, "maximum": 38838.9707, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28073.89 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20868.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 21077.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27129.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 37814.01, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30468.24, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 29341.34, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20868.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22120.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20868.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20868.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 32346.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 32346.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 33389.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32090.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20868.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38838.97 } ] } ] }, { "description": "ASTHMA - SOI : 4", "code_information": [ { "code": "1414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11195.72, "maximum": 11979.42, "payers_information": [ { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11195.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11195.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11979.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11195.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR", "code_information": [ { "code": "518", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35513, "minimum": 24300, "maximum": 66395.8364, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 52378.38 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 35513.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 35868.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 46167.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 64350.06, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 51849.39, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 49931.67, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 35513.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 37644.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 35513.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35513.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 55045.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 55045.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 56821.25, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39031.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 35513.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66395.84 } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC", "code_information": [ { "code": "095", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24641, "minimum": 24641.5, "maximum": 44650.4524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34196.98 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 24887.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32033.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 44650.45, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35976.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 34645.99, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26119.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 38194.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 38194.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 39426.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 30169.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44409.63 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "478", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23515, "minimum": 23400, "maximum": 43324.0243, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34189.81 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 23515.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23750.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30569.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42609.22, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34331.93, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33062.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 23515.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24925.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 23515.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23515.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 36448.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 36448.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 37624.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23515.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23608.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23515, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43324.02 } ] } ] }, { "description": "ATHEROSCLEROSIS WITH MCC", "code_information": [ { "code": "302", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11662, "minimum": 9652.4433, "maximum": 21550.8584, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16080.13 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11662.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11778.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15160.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21132.03, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17026.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16397.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11662.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12362.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11662.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11662.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 18076.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 18076.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18659.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15294.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11662.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21550.86 } ] } ] }, { "description": "BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM - SOI : 3", "code_information": [ { "code": "0493", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15618.45, "maximum": 16711.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15618.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16711.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15618.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15618.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC", "code_information": [ { "code": "094", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33467, "minimum": 33467.7, "maximum": 67594.4443, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51961 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 33467.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 33802.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 43508.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 60643.53, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 48862.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 47055.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 33467.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35475.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 33467.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33467.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 51874.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 51874.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 53548.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 39084.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33467.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67594.44 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "477", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 32859, "minimum": 32859.4, "maximum": 63709.6209, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48322.13 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 32859.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 33187.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 42717.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 59541.27, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 47974.75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 46200.34, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 32859.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 34830.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 32859.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 32859.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 50932.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 50932.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 52575.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52909.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 32859.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63709.62 } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 1", "code_information": [ { "code": "7581", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3371.12, "maximum": 3607.1, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3371.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3607.1, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3371.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3371.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BEHAVIORAL AND DEVELOPMENTAL DISORDERS", "code_information": [ { "code": "886", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19911, "minimum": 9752, "maximum": 36078.9676, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24120.9 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19911.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20110.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25884.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36078.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29070.25, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27995.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19911.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21105.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19911.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19911.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 30862.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 30862.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31857.81, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14541.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19911.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33281.28 } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 1", "code_information": [ { "code": "7531", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3406.1, "maximum": 3644.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3406.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3644.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3406.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3406.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT OR T-CELL IMMUNOTHERAPY- SOI : 4", "code_information": [ { "code": "0084", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 65108.16, "maximum": 69665.73, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 65108.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 69665.73, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 65108.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 65108.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "408", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33901, "minimum": 33750, "maximum": 69082.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53388.14 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 33901.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 34240.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 44071.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 61429.41, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 49496.1, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 47665.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 33901.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35935.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 33901.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33901.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 52547.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 52547.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 54242.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69082.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33901.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64863.77 } ] } ] }, { "description": "BEHAVIORAL DISORDERS - SOI : 4", "code_information": [ { "code": "7584", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22778.37, "maximum": 24372.86, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 22778.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24372.86, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22778.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22778.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 3", "code_information": [ { "code": "7533", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7316.81, "maximum": 7828.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7316.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7828.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUTOLOGOUS BONE MARROW TRANSPLANT WITH CCMCC", "code_information": [ { "code": "016", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56094, "minimum": 56094.6, "maximum": 111818.8139, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88597.75 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 56094.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 56655.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 72922.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 101643.43, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 81898.13, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 78869.02, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 56094.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 59460.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 56094.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56094.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 86946.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 86946.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 89751.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 59494.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 56094.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 111818.81 } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 2", "code_information": [ { "code": "7532", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4274.32, "maximum": 4573.52, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4274.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4573.52, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4274.32, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4274.32, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 3", "code_information": [ { "code": "1383", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6974.4, "maximum": 7462.61, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6974.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7462.61, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6974.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6974.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITHOUT MCC", "code_information": [ { "code": "554", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8221, "minimum": 6587.97, "maximum": 16896.5694, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11787.22 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8303.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10688.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14897.76, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12003.71, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11559.74, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8715.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12743.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12743.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13154.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6587.97 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8221.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15461.49 } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITH MCC", "code_information": [ { "code": "461", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 52276, "minimum": 31950, "maximum": 113686.1968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 97798.89 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 52276.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 52799.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 67959.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 94725.34, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 76323.95, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 73501.01, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 52276.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 55413.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 52276.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 52276.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 81028.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 81028.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 83642.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80681.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 52276.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 113686.2 } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 4", "code_information": [ { "code": "1384", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13157.96, "maximum": 14079.02, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13157.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14079.02, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13157.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13157.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 1", "code_information": [ { "code": "1321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3163.34, "maximum": 3384.77, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3163.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3384.77, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3163.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3163.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "410", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15333, "minimum": 14850, "maximum": 28735.0954, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22449.93 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15333.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15487.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19933.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27784.76, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22387.28, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21559.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15333.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16253.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15333.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15333.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 23767.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 23767.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24534, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24552.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15333.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28735.1 } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 4", "code_information": [ { "code": "1324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10990.06, "maximum": 11759.36, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10990.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11759.36, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10990.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10990.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BIPOLAR DISORDERS - SOI : 4", "code_information": [ { "code": "7534", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13656.21, "maximum": 14612.14, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13656.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14612.14, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13656.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13656.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CCMCC", "code_information": [ { "code": "096", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24641, "minimum": 17415.5592, "maximum": 44650.4524, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31263.81 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 24887.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32033.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 44650.45, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35976.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 34645.99, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26119.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 38194.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 38194.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 39426.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23069.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24641.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 44409.63 } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0561", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4859.5, "maximum": 5199.66, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4859.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5199.66, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4859.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4859.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BONE DISEASES AND ARTHROPATHIES WITH MCC", "code_information": [ { "code": "553", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12598, "minimum": 10611.1683, "maximum": 24194.4649, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19384.79 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12598.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12724.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16377.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22827.96, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18393.39, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17713.08, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12598.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13354.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12598.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12598.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19527.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19527.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20157.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17171.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12598.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24194.46 } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 2", "code_information": [ { "code": "8422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16502.58, "maximum": 17657.76, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16502.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17657.76, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16502.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16502.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITH MCC", "code_information": [ { "code": "725", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11414, "minimum": 9229.326, "maximum": 23390.4529, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17798.44 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11414.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11528.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14838.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20682.97, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16665.08, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16048.7, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11414.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12099.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11414.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11414.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17692.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17692.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18263.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16600.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11414.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23390.45 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CCMCC", "code_information": [ { "code": "584", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20525, "minimum": 15300, "maximum": 37929.3626, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28092.53 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20525.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20730.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26682.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 37191.44, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29966.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28858.26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20525.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21756.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20525.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20525.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31813.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31813.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32840.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37876.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20525.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37929.36 } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 2", "code_information": [ { "code": "1322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4672.92, "maximum": 5000.02, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4672.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5000.02, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4672.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4672.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC", "code_information": [ { "code": "726", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7206, "minimum": 4614.65, "maximum": 18955.9107, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10483.42 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7279, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9369.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13058.96, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10522.12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10132.94, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7639.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11170.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11170.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11531.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4614.65 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7206.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13790.47 } ] } ] }, { "description": "BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "585", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18538, "minimum": 9900, "maximum": 36775.2162, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24100.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 33592.07, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27066.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26065.37, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18538.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19651.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18538.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18538.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 28734.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 28734.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 29661.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35827.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36775.22 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24153.89 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18538.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18724.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18538.7, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0563", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10472.73, "maximum": 11205.82, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10472.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11205.82, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10472.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10472.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 3", "code_information": [ { "code": "3633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22764.59, "maximum": 24358.11, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 22764.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24358.11, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22764.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22764.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 1", "code_information": [ { "code": "3631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9470.93, "maximum": 10133.9, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9470.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10133.9, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9470.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9470.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 4", "code_information": [ { "code": "1964", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14134.31, "maximum": 15123.71, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14134.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15123.71, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14134.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14134.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC", "code_information": [ { "code": "462", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 25400, "minimum": 9900, "maximum": 53053.682, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40824.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 25400.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 25654, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 33020.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 46024.89, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 37084.07, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 35712.47, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 25400.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26924, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 25400.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 25400.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 39370.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 39370.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 40640.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 25400.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28146.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 25400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53053.68 } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 2", "code_information": [ { "code": "1382", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3832.26, "maximum": 4100.52, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3832.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4100.52, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3832.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3832.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 2", "code_information": [ { "code": "3632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16578.9, "maximum": 17739.42, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16578.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17739.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16578.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16578.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH CC", "code_information": [ { "code": "297", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6380, "minimum": 5850, "maximum": 13645.8525, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10450.43 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6444.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8295.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11562.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9316, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8971.43, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6763.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9890.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9890.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10209.31, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9261.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6380.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13049.45 } ] } ] }, { "description": "BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "479", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17879, "minimum": 14850, "maximum": 32897.8031, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26735.66 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17879.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18058.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23243.56, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32397.94, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26104.3, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25138.8, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17879.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18952.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17879.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17879.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27713.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27713.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28607.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19837.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17879.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32897.8 } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITH CCMCC", "code_information": [ { "code": "202", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9546, "minimum": 8664.33, "maximum": 23405.673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13733.58 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9641.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12410.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17297.91, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13937.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13422.11, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10119.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14796.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14796.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15274.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8664.33 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9546.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17908.72 } ] } ] }, { "description": "BRONCHIOLITIS & RSV PNEUMONIA - SOI : 1", "code_information": [ { "code": "1381", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2414.91, "maximum": 2583.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2414.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2583.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2414.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2414.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 3", "code_information": [ { "code": "2013", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7540.49, "maximum": 8068.32, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7540.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8068.32, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7540.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7540.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BPD & OTH CHRONIC RESPIRATORY DISEASES ARISING IN PERINATAL PERIOD - SOI : 3", "code_information": [ { "code": "1323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7546.85, "maximum": 8075.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7546.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8075.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7546.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7546.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRONCHITIS AND ASTHMA WITHOUT CCMCC", "code_information": [ { "code": "203", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6718, "minimum": 5600.13, "maximum": 12904.9497, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9446.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7121.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10414.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10414.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10750.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5600.13 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12904.95 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9967.07 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6785.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6718.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8734.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12174.41, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9809.4, "additional_payer_notes": "146.00% of Medicare Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC", "code_information": [ { "code": "309", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7335, "minimum": 6288.3, "maximum": 13695.9938, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10681.36 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7408.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9536.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13292, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10709.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10313.77, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7775.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11370.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11370.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11736.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6288.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7335.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13695.99 } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0562", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6725.27, "maximum": 7196.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6725.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7196.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6725.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6725.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 1", "code_information": [ { "code": "1911", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7807.64, "maximum": 8354.17, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7807.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8354.17, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7807.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7807.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BRAIN CONTUSIONLACERATION & COMPLICATED SKULL FX, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0564", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17996.26, "maximum": 19256, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17996.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19256, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17996.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17996.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 3", "code_information": [ { "code": "8423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32270.5, "maximum": 34529.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 32270.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34529.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 32270.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 32270.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 1", "code_information": [ { "code": "1921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8493.52, "maximum": 9088.07, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8493.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9088.07, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8493.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8493.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BREAST PROCEDURES EXCEPT MASTECTOMY - SOI : 4", "code_information": [ { "code": "3634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27154.46, "maximum": 29055.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 27154.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29055.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27154.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27154.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 4", "code_information": [ { "code": "1924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25280.2, "maximum": 27049.81, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25280.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27049.81, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25280.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25280.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 1", "code_information": [ { "code": "8421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10311.59, "maximum": 11033.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10311.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11033.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10311.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10311.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 2", "code_information": [ { "code": "1772", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14638.92, "maximum": 15663.64, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14638.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15663.64, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14638.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14638.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "BURNS WITH SKIN GRAFT EXCEPT EXTENSIVE 3RD DEGREE BURNS - SOI : 4", "code_information": [ { "code": "8424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 92524.47, "maximum": 99001.18, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 92524.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 99001.18, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 92524.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 92524.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 1", "code_information": [ { "code": "1961", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3610.7, "maximum": 3863.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3610.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3863.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3610.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3610.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 4", "code_information": [ { "code": "1774", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28401.14, "maximum": 30389.22, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 28401.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 30389.22, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28401.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28401.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITHOUT CCMCC", "code_information": [ { "code": "298", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 4701, "minimum": 4701.38, "maximum": 9199.9251, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6306.69 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 4748.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 6111.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 8518.9, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 6864.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 6610.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 4983.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 7287.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 7287.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7522.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5807.41 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 4701.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8182.77 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "258", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29925, "minimum": 21600, "maximum": 54225.5496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38849.91 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 30225.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38903.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 54225.55, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43691.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 42075.67, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 31721.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 46384.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 46384.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 47881.28, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 36885.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 29925.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 51973.64 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 4", "code_information": [ { "code": "2014", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13236.41, "maximum": 14162.96, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13236.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14162.96, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13236.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13236.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC", "code_information": [ { "code": "261", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18176, "minimum": 13500, "maximum": 35154.2241, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26990.98 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18176.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18358.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23629.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32935.47, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26537.41, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25555.89, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18176.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19266.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18176.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18176.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 28173.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 28173.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 29082.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32858.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18176.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35154.22 } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC", "code_information": [ { "code": "308", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11731, "minimum": 8972.3877, "maximum": 22340.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17243.36 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11731.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11849.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15251.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21257.91, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17128.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16494.83, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11731.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12435.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11731.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11731.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 18184.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 18184.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18770.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11360.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11731.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22340.05 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 1", "code_information": [ { "code": "2001", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3867.24, "maximum": 4137.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3867.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4137.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3867.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3867.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 2", "code_information": [ { "code": "1962", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4660.2, "maximum": 4986.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4660.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4986.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4660.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4660.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 2", "code_information": [ { "code": "1912", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9237.71, "maximum": 9884.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9237.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9884.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9237.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9237.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 1", "code_information": [ { "code": "2011", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3796.22, "maximum": 4061.96, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3796.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4061.96, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3796.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3796.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH CC", "code_information": [ { "code": "035", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22870, "minimum": 8550, "maximum": 42142.0895, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32982.11 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23098.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 29731.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 41440.62, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33390.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 32155.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24242.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 35448.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 35448.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 36592.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32562 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22870.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42142.09 } ] } ] }, { "description": "CARDIAC ARREST & SHOCK - SOI : 3", "code_information": [ { "code": "1963", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7462.04, "maximum": 7984.38, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7462.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7984.38, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7462.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7462.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 3", "code_information": [ { "code": "1913", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12200.69, "maximum": 13054.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12200.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13054.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12200.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12200.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "310", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5743, "minimum": 5341.92, "maximum": 10407.0408, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7931.77 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 5800.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7466.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 10407.04, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8385.36, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8075.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6088, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 8902.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 8902.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 9189.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5341.92 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 5743.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10365.09 } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "036", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18667, "minimum": 5400, "maximum": 33959.3214, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25935.32 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18667.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18853.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24267.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 33825.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27254.23, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26246.2, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18667.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19787.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18667.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18667.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 28934.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 28934.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 29867.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26658.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18667.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33959.32 } ] } ] }, { "description": "CARDIAC ARREST, UNEXPLAINED WITH MCC", "code_information": [ { "code": "296", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15091, "minimum": 9000, "maximum": 30352.3824, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22994.97 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15091.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15242.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19619.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27345.89, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22033.66, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21218.72, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15091.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15996.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15091.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15091.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 23391.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 23391.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24146.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27306.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15091.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30352.38 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 3", "code_information": [ { "code": "1923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15382.05, "maximum": 16458.79, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15382.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16458.79, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15382.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15382.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE- SOI : 4", "code_information": [ { "code": "1914", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18727.73, "maximum": 20038.67, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18727.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20038.67, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18727.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18727.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS - SOI : 2", "code_information": [ { "code": "2012", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5121.34, "maximum": 5479.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5121.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5479.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5121.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5121.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC", "code_information": [ { "code": "306", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15222, "minimum": 9404.4531, "maximum": 27740.2694, "payers_information": [ { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15222.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15374.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19788.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27582.34, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22224.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21402.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15222.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16135.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15222.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15222.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 23594.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 23594.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24355.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15222.04, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19686.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15222, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27740.27 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22042.58 } ] } ] }, { "description": "CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS - SOI : 2", "code_information": [ { "code": "1922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10796.06, "maximum": 11551.78, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10796.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11551.78, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10796.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10796.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC", "code_information": [ { "code": "307", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9001, "minimum": 7236.4563, "maximum": 17162.1381, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13519.87 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9091.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11702.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16311.32, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13142.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12656.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9541.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13952.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13952.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14402.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10497.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9001.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17162.14 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH MCC", "code_information": [ { "code": "276", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56816, "minimum": 27900, "maximum": 114755.1253, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89073.95 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 56816.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 57384.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 73861.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 102951.52, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 82952.1, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 79884.01, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 56816.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 60225.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 56816.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56816.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 88065.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 88065.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 90906.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 44624.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 56816.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 114755.13 } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC", "code_information": [ { "code": "275", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 67366, "minimum": 37350, "maximum": 130920.5848, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 100915.67 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 67366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 68039.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 87576.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 122067.68, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 98354.75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 94716.98, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 67366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 71408.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 67366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 104417.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 104417.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 107786.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 77132.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 67366.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 130920.58 } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 1", "code_information": [ { "code": "1771", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9740.2, "maximum": 10422.01, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9740.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10422.01, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9740.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9740.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 4", "code_information": [ { "code": "2004", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15253.78, "maximum": 16321.54, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15253.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16321.54, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15253.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15253.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC", "code_information": [ { "code": "277", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43785, "minimum": 14850, "maximum": 86179.3503, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 68594.77 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 43785.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 44223.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56921.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 79339.54, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 63927.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 61562.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 43785.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 46412.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 43785.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43785.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 67867.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 67867.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 70056.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 63458.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 43785.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 86179.35 } ] } ] }, { "description": "CARDIAC PACEMAKER & DEFIBRILLATOR REVISION EXCEPT DEVICE REPLACEMENT - SOI : 3", "code_information": [ { "code": "1773", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18511.47, "maximum": 19807.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18511.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19807.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18511.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18511.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "221", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 47744, "minimum": 13950, "maximum": 86512.7803, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85080.78 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66675.66 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 47744.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 48221.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 62067.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 86512.78, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 69706.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 67128.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 47744.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 50609.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 47744.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 47744.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 74003.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 74003.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 76390.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 47744.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51682.8 } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC", "code_information": [ { "code": "260", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30965, "minimum": 24166.2615, "maximum": 69981.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47550.48 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 31274.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40254.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 56108.58, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45208.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 43536.79, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 32822.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 47995.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 47995.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 49544, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69981.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30965, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63101.98 } ] } ] }, { "description": "CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC", "code_information": [ { "code": "259", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19411, "minimum": 10800, "maximum": 41580.5424, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26772.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19605.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25235.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 35174.02, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28341.1, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27292.86, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20576.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 30088.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 30088.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31058.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23108.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19411.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32562.49 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1624", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 80771.14, "maximum": 86425.12, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 80771.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 86425.12, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 80771.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 80771.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITHOUT CCMCC", "code_information": [ { "code": "262", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15729, "minimum": 9000, "maximum": 39082.7442, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23598.82 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15729.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15887.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20448.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28502.6, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22965.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22116.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15729.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16673.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15729.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15729.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24381.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24381.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25167.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19955.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15729.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28118.19 } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 2", "code_information": [ { "code": "2002", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5660.93, "maximum": 6057.2, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5660.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6057.2, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5660.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5660.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 31937.63, "maximum": 34173.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 31937.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34173.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31937.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31937.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC STRUCTURAL & VALVULAR DISORDERS - SOI : 3", "code_information": [ { "code": "2003", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8622.85, "maximum": 9226.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8622.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9226.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8622.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8622.85, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 2", "code_information": [ { "code": "3832", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5117.1, "maximum": 5475.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5117.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5475.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5117.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5117.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "217", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62155, "minimum": 23400, "maximum": 119636.6272, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 91298.57 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 62776.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 80801.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 112625.26, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 90746.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 87390.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 65884.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 96340.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 96340.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 99448.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62209.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 119636.63 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36891.48, "maximum": 39473.88, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 36891.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39473.88, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36891.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36891.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "216", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 92265, "minimum": 48150, "maximum": 178792.6498, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 139204.76 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 92265.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 93188.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 119945.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 167185.76, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 134708.17, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 129725.81, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 92265.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 97801.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 92265.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 92265.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 143012.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 143012.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 147625.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 135945 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 92265.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 178792.65 } ] } ] }, { "description": "CELLULITIS WITHOUT MCC", "code_information": [ { "code": "603", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8604, "minimum": 6765.64, "maximum": 18817.8543, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12689.4 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8690.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11186.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15591.79, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12562.92, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12098.26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9121.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13337.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13337.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13767.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6765.64 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8604.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16317.37 } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "219", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 72509, "minimum": 38250, "maximum": 143342.0157, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 110603.05 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 72509.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 73234.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 94262.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 131387.61, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 105864.19, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 101948.67, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 72509.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 76860.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 72509.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72509.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 112390.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 112390.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 116015.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 90100.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 72509.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 143342.02 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 2", "code_information": [ { "code": "2052", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5360.93, "maximum": 5736.2, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5360.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5736.2, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5360.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5360.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITHOUT CCMCC", "code_information": [ { "code": "218", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 62155, "minimum": 10350, "maximum": 112625.2586, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81708.73 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 62776.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 80801.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 112625.26, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 90746.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 87390.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 65884.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 96340.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 96340.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 99448.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 78218.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 62155.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 110214.49 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "473", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23346, "minimum": 7200, "maximum": 43857.5623, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35292.8 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 23346.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23580.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30351.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42304.73, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34086.59, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 32825.85, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 23346.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24747.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 23346.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23346.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 36187.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 36187.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 37355.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23346.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27905.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23347, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43857.56 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1621", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38042.75, "maximum": 40705.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 38042.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 40705.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38042.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38042.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 3", "code_information": [ { "code": "2053", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8170.19, "maximum": 8742.1, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8170.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8742.1, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8170.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8170.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC", "code_information": [ { "code": "220", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 50491, "minimum": 25200, "maximum": 98124.6726, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 75224.18 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 50491.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 50996.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 65638.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 91489.98, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 73717.09, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 70990.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 50491.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 53520.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 50491.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 50491.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 78261.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 78261.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 80785.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62083.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 50491.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 98124.67 } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 3", "code_information": [ { "code": "5403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9359.2, "maximum": 10014.34, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9359.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10014.34, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9359.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9359.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1622", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44276.14, "maximum": 47375.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 44276.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 47375.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 44276.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 44276.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CAROTID ARTERY STENT PROCEDURES WITH MCC", "code_information": [ { "code": "034", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36765, "minimum": 21150, "maximum": 72040.594, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 55958.44 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 36765.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 37133.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 47795.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 66619.25, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53677.76, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 51692.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 36765.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 38971.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 36765.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36765.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 56986.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 56986.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 58824.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 51127.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 36765.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 72040.59 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1623", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 57853.9, "maximum": 61903.67, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 57853.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 61903.67, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 57853.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 57853.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH CC", "code_information": [ { "code": "784", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10380, "minimum": 7540, "maximum": 20063.2508, "payers_information": [ { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10380.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10484.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13495.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10380.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11003.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10380.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10380.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16090.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16090.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10878.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10380.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20063.25 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14688.84 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 1", "code_information": [ { "code": "2051", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4035.8, "maximum": 4318.31, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4035.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4318.31, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4035.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4035.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48537.74, "maximum": 51935.38, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 48537.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 51935.38, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48537.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48537.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH CC", "code_information": [ { "code": "787", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10913, "minimum": 7540, "maximum": 19670.5076, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15076.11 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10913.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11022.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14187.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10913.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11567.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10913.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10913.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16915.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16915.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16101.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10913.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19670.51 } ] } ] }, { "description": "CARDIAC VALVE PROCEDURES WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 71005.5, "maximum": 75975.89, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 71005.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 75975.89, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 71005.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 71005.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITH MCC", "code_information": [ { "code": "786", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15913, "minimum": 7540, "maximum": 29935.5558, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25093.38 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16073.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20688.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16868.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24666.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24666.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15913.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29935.56 } ] } ] }, { "description": "CARDIOMYOPATHY - SOI : 4", "code_information": [ { "code": "2054", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15093.7, "maximum": 16150.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15093.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16150.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15093.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15093.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 4", "code_information": [ { "code": "6954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39025.46, "maximum": 41757.24, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 39025.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 41757.24, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39025.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39025.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC", "code_information": [ { "code": "837", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45529, "minimum": 26683.2342, "maximum": 92761.5045, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69478.31 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 45529.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 45985.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 59188.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 82500.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66473.55, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 64014.94, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 45529.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 48261.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 45529.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45529.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 70571.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 70571.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 72847.73, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 60264.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 45529.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 92761.5 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC", "code_information": [ { "code": "847", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12709, "minimum": 10704, "maximum": 23540.5104, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17392.53 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12709.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12837, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16522.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23030.38, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18556.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17870.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12709.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13472.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12709.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12709.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19700.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19700.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20335.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10704 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12709.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23540.51 } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 3", "code_information": [ { "code": "3833", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7731.31, "maximum": 8272.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7731.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8272.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7731.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7731.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 2", "code_information": [ { "code": "2032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4785.29, "maximum": 5120.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4785.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5120.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4785.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4785.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH MCC", "code_information": [ { "code": "471", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45758, "minimum": 31950, "maximum": 89984.5135, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45758.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 70926.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 70926.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 73214.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 52177.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89984.51 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70554.05 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 45758.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 46216.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 59486.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 82915.09, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 66807.96, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 64336.99, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 45758.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 48504.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 45758.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45758.9, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEST PAIN - SOI : 3", "code_information": [ { "code": "2033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6017.13, "maximum": 6438.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6017.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6438.33, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6017.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6017.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 1", "code_information": [ { "code": "5401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5389.76, "maximum": 5767.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5389.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5767.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5389.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5389.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 2", "code_information": [ { "code": "5402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6800.75, "maximum": 7276.8, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6800.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7276.8, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6800.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6800.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN DELIVERY - SOI : 4", "code_information": [ { "code": "5404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21052.9, "maximum": 22526.6, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21052.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22526.6, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21052.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21052.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 1", "code_information": [ { "code": "5391", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5511.04, "maximum": 5896.81, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5511.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5896.81, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5511.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5511.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 3", "code_information": [ { "code": "5393", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11858.17, "maximum": 12688.24, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11858.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12688.24, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11858.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11858.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 2", "code_information": [ { "code": "2632", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11931.43, "maximum": 12766.63, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11931.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12766.63, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11931.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11931.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 4", "code_information": [ { "code": "5394", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24337.19, "maximum": 26040.79, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 24337.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26040.79, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24337.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24337.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 3", "code_information": [ { "code": "6953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16628.73, "maximum": 17792.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16628.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17792.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16628.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16628.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 1", "code_information": [ { "code": "3831", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3744.27, "maximum": 4006.37, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3744.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4006.37, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3744.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3744.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 3", "code_information": [ { "code": "4703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8182.91, "maximum": 8755.71, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8182.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8755.71, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8182.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8182.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "788", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9429, "minimum": 7540, "maximum": 16760.132, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12263.41 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9524.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12258.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9995.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14616.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14616.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11767.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9429.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16760.13 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "848", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8402, "minimum": 8402.9, "maximum": 34635.5385, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11993.76 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8486.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10923.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15226.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12268.23, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11814.48, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8907.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13024.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13024.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13444.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8632.35 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8402.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15170.63 } ] } ] }, { "description": "CELLULITIS & OTHER SKIN INFECTIONS - SOI : 4", "code_information": [ { "code": "3834", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14332.55, "maximum": 15335.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14332.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15335.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14332.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14332.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 4", "code_information": [ { "code": "4704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14561.53, "maximum": 15580.84, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14561.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15580.84, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14561.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14561.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 1", "code_information": [ { "code": "6951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5846.45, "maximum": 6255.7, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5846.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6255.7, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5846.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5846.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES", "code_information": [ { "code": "018", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 405810, "minimum": 55350, "maximum": 735329.3689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 528441.06 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 405810.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 409869.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 527554.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 735329.37, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 592483.93, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 570570.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 405810.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 430159.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 405810.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 405810.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 629006.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 629006.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 649297.46, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 405810.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 430224 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 405811, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 698653.15 } ] } ] }, { "description": "CELLULITIS WITH MCC", "code_information": [ { "code": "602", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13771, "minimum": 11132.7147, "maximum": 27217.8468, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21335.46 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13771.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13909.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17903.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24954.25, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20106.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19362.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13771.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14598, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13771.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13771.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21346.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21346.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22034.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15033.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13771.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27217.85 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12433.91, "maximum": 13304.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12433.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13304.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12433.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12433.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEST PAIN", "code_information": [ { "code": "313", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7188, "minimum": 7188.15, "maximum": 13216.1802, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10378.72 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7260.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9344.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13024.93, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10494.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10106.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7619.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11141.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11141.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11501.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7762.95 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13216.18 } ] } ] }, { "description": "CERVICAL SPINAL FUSION WITH CC", "code_information": [ { "code": "472", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 28085, "minimum": 11250, "maximum": 53672.4379, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42389.81 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 28085.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 28366.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 36511.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 50891.52, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 41005.31, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 39488.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 28085.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 29770.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 28085.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28085.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 43533.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 43533.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 44937.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32660.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 28085.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53672.44 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "286", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21201, "minimum": 13679.0883, "maximum": 41002.7636, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30918.14 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 21201.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 21413.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27562.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 38417.88, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30954.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 29809.9, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 21201.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22474.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 21201.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21201.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 32862.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 32862.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 33923.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24144 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21201.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41002.76 } ] } ] }, { "description": "CHEST PAIN - SOI : 1", "code_information": [ { "code": "2031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4004, "maximum": 4284.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4004 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4284.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4004, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4004, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH MCC", "code_information": [ { "code": "411", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31439, "minimum": 25650, "maximum": 56967.613, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43608.97 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 31439.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 31753.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40870.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 56967.61, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45901.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 44203.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 31439.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33325.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 31439.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31439.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 48730.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 48730.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 50302.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35976.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 31439.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50693.52 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITH MCC", "code_information": [ { "code": "783", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23476, "minimum": 7540, "maximum": 36388.6215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25413.22 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 23476.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23711.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30519.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 23476.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24885.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 23476.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23476.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 36388.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 36388.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17241 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23476.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34126.05 } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "433", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10344, "minimum": 10344.25, "maximum": 19818.7126, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14787.81 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10344.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10447.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13447.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18743.78, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15102.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14544.02, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10344.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10964.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10344.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10344.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16033.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16033.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16550.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11954.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10344.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19818.71 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC", "code_information": [ { "code": "415", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19830, "minimum": 19830.4, "maximum": 36645.5368, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25779.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 35932.68, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28952.38, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27881.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21020.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 30737.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 30737.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31728.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26593.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36645.54 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28339.23 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20028.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19830.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "413", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16017, "minimum": 12600, "maximum": 30798.8499, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21652.45 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16017.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16177.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20822.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29023.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23385.07, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22520.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16017.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16978.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16017.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16017.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24826.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24826.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25627.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21858 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16017.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30798.85 } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION WITHOUT CCMCC", "code_information": [ { "code": "785", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9420, "minimum": 7540, "maximum": 16182.1326, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12425.49 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9514.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12246.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13628, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10275, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9985.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14601.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14601.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 7540, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9025.59 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9420.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16182.13 } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 2", "code_information": [ { "code": "0952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8045.1, "maximum": 8608.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8045.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8608.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8045.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CCMCC", "code_information": [ { "code": "416", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13227, "minimum": 12600, "maximum": 26910.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19208.38 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13227.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13359.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17195.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23967.65, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19311.68, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18597.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13227.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14020.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13227.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13227.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 20502.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 20502.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21163.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 26910.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13227.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25383.81 } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 1", "code_information": [ { "code": "2631", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9312.98, "maximum": 9964.89, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9312.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9964.89, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9312.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9312.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CESAREAN SECTION WITH STERILIZATION- SOI : 2", "code_information": [ { "code": "5392", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6779.76, "maximum": 7254.34, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6779.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7254.34, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6779.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6779.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 4", "code_information": [ { "code": "2634", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27036.79, "maximum": 28929.37, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 27036.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28929.37, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27036.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27036.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY- SOI : 3", "code_information": [ { "code": "2633", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16322.36, "maximum": 17464.93, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16322.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17464.93, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16322.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16322.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY FOR ACUTE LEUKEMIA - SOI : 2", "code_information": [ { "code": "6952", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8459.6, "maximum": 9051.77, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8459.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9051.77, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8459.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8459.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 2", "code_information": [ { "code": "4702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4928.4, "maximum": 5273.39, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4928.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5273.39, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4928.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4928.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC KIDNEY DISEASE - SOI : 1", "code_information": [ { "code": "4701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3852.4, "maximum": 4122.07, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3852.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4122.07, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3852.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3852.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT", "code_information": [ { "code": "838", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20024, "minimum": 18417.2, "maximum": 37573.6706, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28710.72 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20024.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20224.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26032.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36284.79, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29236.09, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28154.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20024.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21226.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20024.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20024.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31038.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31038.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32039.55, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18417.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20024.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37573.67 } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 3", "code_information": [ { "code": "6613", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11209.5, "maximum": 11994.17, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11209.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11994.17, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11209.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11209.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7406.92, "maximum": 7925.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7406.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7925.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7406.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7406.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC", "code_information": [ { "code": "191", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8342, "minimum": 8342.82, "maximum": 15915.3636, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10845.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15117.19, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12180.52, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11730, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8843.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12931.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12931.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13348.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9515.96 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15915.36 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12177.35 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8426.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8342.82, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "839", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13983, "minimum": 12182.2, "maximum": 41351.7267, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18690.58 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13983.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14123.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18178.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 25338.68, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20416.38, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19661.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13983.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14822.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13983.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13983.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21674.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21674.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22374.11, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12182.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13983.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25387.52 } ] } ] }, { "description": "COAGULATION DISORDERS", "code_information": [ { "code": "813", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14747, "minimum": 14747.97, "maximum": 28677.666, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22375.34 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 14747.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14895.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19172.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26723.32, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21532.04, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20735.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 14747.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15632.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 14747.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14747.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 22859.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 22859.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23596.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14747.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14818.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14748, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28677.67 } ] } ] }, { "description": "CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC", "code_information": [ { "code": "846", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24766, "minimum": 16722.7206, "maximum": 47310.7386, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35054.7 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 24766.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 25014.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 32196.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 44876.7, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 36158.93, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 34821.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 24766.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26252.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 24766.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24766.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 38387.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 38387.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 39626.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18470.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24766.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 47310.74 } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC", "code_information": [ { "code": "453", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 127100.56, "maximum": 127100.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 127100.56 } ] } ] }, { "description": "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "287", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10474, "minimum": 9450, "maximum": 34593.3546, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15513.57 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10474.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10579.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13617.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18980.23, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15293.12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14727.48, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10474.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11103.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10474.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10474.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16235.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16235.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16759.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14356.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10474.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20187.37 } ] } ] }, { "description": "CHEST PAIN - SOI : 4", "code_information": [ { "code": "2034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9476.23, "maximum": 10139.57, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9476.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10139.57, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9476.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9476.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITHOUT CCMCC", "code_information": [ { "code": "382", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7944, "minimum": 7022.67, "maximum": 14395.9595, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10859.22 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8024.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10328.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14395.96, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11599.39, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11170.37, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8421.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12314.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12314.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12711.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7022.67 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7944.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13881.25 } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 2", "code_information": [ { "code": "7742", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3481.37, "maximum": 3725.07, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3481.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3725.07, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3481.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3481.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "432", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18905, "minimum": 18905.7, "maximum": 36293.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27481.52 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18905.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19094.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24577.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34257.16, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27602.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26581.44, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18905.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20040.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18905.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18905.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29303.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29303.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30249.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23464.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18905.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36293.55 } ] } ] }, { "description": "CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC", "code_information": [ { "code": "414", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 33873, "minimum": 33873.27, "maximum": 64910.0814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 50562.54 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 33873.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 34212.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 44035.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 61378.37, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 49454.97, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 47625.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 33873.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35905.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 33873.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 33873.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 52503.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 52503.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 54197.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46066 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 33873.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 64910.08 } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 2", "code_information": [ { "code": "0572", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6917.15, "maximum": 7401.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6917.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7401.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6917.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6917.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC", "code_information": [ { "code": "454", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 87727.12, "maximum": 87727.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87727.12 } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 1", "code_information": [ { "code": "0951", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7198.08, "maximum": 7701.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7198.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7701.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7198.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7198.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHOLECYSTECTOMY WITH C.D.E. WITH CC", "code_information": [ { "code": "412", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20166, "minimum": 19800, "maximum": 39489.2201, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29634.42 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20166.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20368.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26216.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36541.64, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29443.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28354.06, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20166.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21376.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20166.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20166.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31258.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31258.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32266.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28025.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20166.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39489.22 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 3", "code_information": [ { "code": "3463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11432.12, "maximum": 12232.37, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11432.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12232.37, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11432.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11432.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "455", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66058.9, "maximum": 66058.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 66058.9 } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 4", "code_information": [ { "code": "0954", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19181.45, "maximum": 20524.15, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 19181.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20524.15, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19181.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19181.45, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4604.01, "maximum": 4926.29, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4604.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4926.29, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4604.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4604.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 3", "code_information": [ { "code": "3843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8929.22, "maximum": 9554.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8929.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9554.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8929.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8929.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH MCC", "code_information": [ { "code": "380", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18849, "minimum": 17731.4, "maximum": 35648.8583, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27947.67 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19037.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24504.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34155.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27520.12, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26502.26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19980.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29216.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29216.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30159.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17731.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18849.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35648.86 } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5528.42, "maximum": 5915.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5528.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5915.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5528.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5528.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1653", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 46931.69, "maximum": 50216.91, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 46931.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 50216.91, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 46931.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 46931.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH CC", "code_information": [ { "code": "920", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9838, "minimum": 8799.8172, "maximum": 18820.1814, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14827.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9936.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12789.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17826.93, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14363.86, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13832.59, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10428.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 15249.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15741.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9782.46 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9838.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18820.18 } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 1", "code_information": [ { "code": "6611", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6078.61, "maximum": 6504.11, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6078.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6504.11, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6078.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6078.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC", "code_information": [ { "code": "190", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10827, "minimum": 10695.7, "maximum": 20804.2758, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15806.17 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10827.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10935.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14076.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19619.81, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15808.46, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15223.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10827.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11477.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10827.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10827.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16782.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16782.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17324.34, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10695.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10827.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20804.28 } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1654", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 63659, "maximum": 68115.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 63659 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 68115.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 63659, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 63659, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION WITHOUT CCMCC", "code_information": [ { "code": "090", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8156, "minimum": 8156.95, "maximum": 15882.0175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13407.99 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8238.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10604.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14780.39, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11909.15, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11468.67, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8646.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12643.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12643.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13051.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14760.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8156.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15882.02 } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 4", "code_information": [ { "code": "7744", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15091.58, "maximum": 16147.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15091.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16147.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15091.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15091.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CCMCC", "code_information": [ { "code": "192", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6455, "minimum": 5930.6, "maximum": 11989.7839, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9205.45 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6520.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8392.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11698.13, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9425.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9077.02, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6843.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10006.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10006.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10329.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5930.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6455.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11989.78 } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC", "code_information": [ { "code": "233", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 72198, "minimum": 50850, "maximum": 144803.6874, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 111870.98 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 72198.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 72920.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 93858.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 130824.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 105410.53, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 101511.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 72198.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 76530.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 72198.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 72198.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 111908.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 111908.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 115518.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 72198.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 92950.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 72199, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 144803.69 } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 3", "code_information": [ { "code": "0573", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9804.86, "maximum": 10491.2, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9804.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10491.2, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9804.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9804.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "434", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7117, "minimum": 7117.74, "maximum": 12903.0971, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9602.75 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7188.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9253.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12897.34, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10391.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10007.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7544.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11032.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11388.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7874.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7117.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12903.1 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITHOUT MCC", "code_information": [ { "code": "232", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57342, "minimum": 34200, "maximum": 113167.4793, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 85321.77 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 57342.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 57915.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 74544.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 103904.08, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 83719.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 80623.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 57342.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 60782.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 57342.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57342.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 88880.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 88880.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 91747.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.21, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 80314.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 57342.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 113167.48 } ] } ] }, { "description": "Conization Of Cervix", "code_information": [ { "code": "57522", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9450, "discounted_cash": 4143, "minimum": 321.98, "maximum": 9450, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4391.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 321.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6421.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6421.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 321.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5457.89, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5294.15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6214.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4184.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 321.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5800.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6048.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5825.17, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 344.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "COMPLICATED PEPTIC ULCER WITH CC", "code_information": [ { "code": "381", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10600, "minimum": 10600.5, "maximum": 20176.2571, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15390.22 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10600.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10706.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13780.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19208.16, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15476.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14904.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10600.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11236.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10600.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10600.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16430.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16430.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16960.85, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11892 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10600.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20176.26 } ] } ] }, { "description": "CLEFT LIP & PALATE REPAIR - SOI : 3", "code_information": [ { "code": "0953", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10607.36, "maximum": 11349.88, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10607.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11349.88, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10607.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10607.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC", "code_information": [ { "code": "235", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 55521, "minimum": 36450, "maximum": 109008.4767, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 84346.44 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 55521.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 56076.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 72177.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 100604.09, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 81060.69, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 78062.55, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 55521.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 58852.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 55521.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 55521.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 86057.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 86057.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 88833.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 55521.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 71629.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 55521, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 109008.48 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 2", "code_information": [ { "code": "3462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7614.7, "maximum": 8147.73, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7614.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8147.73, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7614.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7614.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITH MCC", "code_information": [ { "code": "919", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17615, "minimum": 12812.4009, "maximum": 33783.3279, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26171.98 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17615.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17792.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22900.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31919.96, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25719.17, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 24767.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17615.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18672.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17615.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17615.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27304.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27304.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28185.39, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16889.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17615.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33783.33 } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 2", "code_information": [ { "code": "6612", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7714.35, "maximum": 8254.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7714.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8254.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7714.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7714.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 4", "code_information": [ { "code": "1664", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 55046.75, "maximum": 58900.02, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 55046.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 58900.02, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55046.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55046.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 2", "code_information": [ { "code": "3842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6140.1, "maximum": 6569.91, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6140.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6569.91, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6140.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6140.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES", "code_information": [ { "code": "212", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 102510, "minimum": 56250, "maximum": 201816.2953, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 154485.97 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 102510.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 103536.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 133263.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 185749.1, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 149665.39, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 144129.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 102510.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 108661.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 102510.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 102510.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 158891.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 158891.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 164016.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 102510.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 143227 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 102511, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 201816.3 } ] } ] }, { "description": "COAGULATION & PLATELET DISORDERS - SOI : 4", "code_information": [ { "code": "6614", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19298.06, "maximum": 20648.92, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 19298.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20648.92, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19298.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19298.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC", "code_information": [ { "code": "323", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41052, "minimum": 20700, "maximum": 78908.0429, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59380.72 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 41052.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 41463.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 53368.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 74387.84, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 59937.22, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 57720.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 41052.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43516.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 41052.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41052.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 63631.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 63631.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 65684.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 62646.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 41052.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 78908.04 } ] } ] }, { "description": "CORONARY BYPASS WITH PTCA WITH MCC", "code_information": [ { "code": "231", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 79565, "minimum": 48600, "maximum": 156984.2852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 116397.68 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 79565.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 80361.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 103435.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 144172.54, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 116165.51, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 111868.98, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 79565.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 84339.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 79565.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 79565.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 123326.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 123326.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 127304.67, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 70171 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 79565.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 156984.29 } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 1", "code_information": [ { "code": "0571", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4449.24, "maximum": 4760.69, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4449.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4760.69, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4449.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4449.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 1", "code_information": [ { "code": "7741", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2749.9, "maximum": 2942.39, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2749.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2942.39, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2749.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2749.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC", "code_information": [ { "code": "236", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39751, "minimum": 26100, "maximum": 76179.2185, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 57963.61 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 39751.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 40149.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 51677.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 72030.21, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 58037.58, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 55890.99, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 39751.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 42136.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 39751.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39751.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 61615.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 61615.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 63602.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 57891.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 39751.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 76179.22 } ] } ] }, { "description": "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HR OR NO COMA - SOI : 4", "code_information": [ { "code": "0574", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16634.03, "maximum": 17798.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16634.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17798.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16634.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16634.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COCAINE ABUSE & DEPENDENCE - SOI : 3", "code_information": [ { "code": "7743", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5959.88, "maximum": 6377.07, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5959.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6377.07, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5959.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5959.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 3", "code_information": [ { "code": "0453", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10803.48, "maximum": 11559.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10803.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11559.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10803.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10803.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1661", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29768.67, "maximum": 31852.48, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 29768.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31852.48, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29768.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29768.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 4", "code_information": [ { "code": "3464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21898.49, "maximum": 23431.38, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21898.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23431.38, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21898.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21898.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "COMPLICATIONS OF TREATMENT WITHOUT CCMCC", "code_information": [ { "code": "921", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6891, "minimum": 6891.5, "maximum": 22362.5802, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10008.66 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6960.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8958.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12487.4, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10061.59, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9689.45, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7304.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10681.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10681.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11026.4, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7119.79 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6891.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12740.07 } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "026", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 29616, "minimum": 13500, "maximum": 56662.4736, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42356.82 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 29616.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 29913.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 38502.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 53665.91, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43240.75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 41641.43, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 29616.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 31394.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 29616.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 29616.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 45906.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 45906.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 47387.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 29616.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33641 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 29617, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 56662.47 } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 4", "code_information": [ { "code": "3844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15409.61, "maximum": 16488.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15409.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16488.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15409.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15409.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION WITH CC", "code_information": [ { "code": "089", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10742, "minimum": 10742.29, "maximum": 19861.3215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16493.21 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10742.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10849.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13964.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19465.03, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15683.74, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15103.66, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10742.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11386.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10742.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10742.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16650.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16650.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17187.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18018 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10742.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19861.32 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA", "code_information": [ { "code": "955", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 63617, "minimum": 39600, "maximum": 126498.5184, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 92882, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 89446.64, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 63617.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 67434.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 63617.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 63617.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 98607.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 98607.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 101788.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 118563 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 126498.52 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87352.77 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 63617.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 64253.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 63617.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 82703.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 115275.47, "additional_payer_notes": "181.20% of Medicare Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 1", "code_information": [ { "code": "1651", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 35209.1, "maximum": 37673.74, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 35209.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 37673.74, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 35209.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 35209.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONCUSSION WITH MCC", "code_information": [ { "code": "088", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13119, "minimum": 13119.2, "maximum": 26134.0978, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21999.55 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13119.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13250.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17054.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23772.03, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19154.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18445.62, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13119.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13906.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13119.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13119.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 20334.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 20334.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20990.75, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18547.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13119.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26134.1 } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33747.22, "maximum": 36109.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 33747.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36109.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33747.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33747.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS W AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1652", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38566.44, "maximum": 41266.09, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 38566.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 41266.09, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38566.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38566.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS - SOI : 1", "code_information": [ { "code": "3461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5540.08, "maximum": 5927.89, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5540.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5927.89, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5540.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5540.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 3", "code_information": [ { "code": "1313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17564.8, "maximum": 18794.34, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17564.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18794.34, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17564.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17564.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 56988.86, "maximum": 60978.08, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 56988.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 60978.08, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 56988.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 56988.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC", "code_information": [ { "code": "234", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 51710, "minimum": 36450, "maximum": 98560.0248, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 74554.36 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 51710.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 52227.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 67223.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 93699.63, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 75497.49, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 72705.12, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 51710.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 54813.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 51710.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 51710.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 80151.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 80151.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 82736.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 76237.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 51710.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 98560.02 } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH CC", "code_information": [ { "code": "546", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11256, "minimum": 10689.1446, "maximum": 21447.1149, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17201.77 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11256.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11369.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14633.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20397.19, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16434.83, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15826.96, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11256.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11932.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11256.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11256.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17447.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17447.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18010.77, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14886.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11256.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21447.11 } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 3", "code_information": [ { "code": "1663", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39961.53, "maximum": 42758.84, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 39961.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42758.84, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39961.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39961.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITH MCC", "code_information": [ { "code": "545", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23726, "minimum": 14743.9122, "maximum": 46812.3993, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35760.39 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 23726.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23963.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30844.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42991.95, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34640.31, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33359.09, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 23726.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 25149.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 23726.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23726.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 36775.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 36775.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 37961.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28710.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23726.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46812.4 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITHOUT CCMCC", "code_information": [ { "code": "295", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5817.5433, "maximum": 14631.5378, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11432.94 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10384.2 }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14631.54 } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC", "code_information": [ { "code": "073", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15489, "minimum": 15489.58, "maximum": 28633.2045, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24008.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24008.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24783.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17823.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28633.2 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21701.22 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15489.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15644.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20136.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28067.12, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22614.79, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21778.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15489.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16418.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15489.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15489.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15489.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "547", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8278, "minimum": 8278.99, "maximum": 24682.6947, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11808.73 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8361.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10762.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15001.53, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12087.33, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11640.26, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8775.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12832.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12832.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13246.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9571.63 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8278.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13823.82 } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 1", "code_information": [ { "code": "1791", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28107.49, "maximum": 30075.01, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 28107.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 30075.01, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28107.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28107.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "025", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 43111, "minimum": 29250, "maximum": 82852.1482, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 63339.44 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 43111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 43542.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 56045.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 78118.2, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 62942.92, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 60614.9, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 43111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45698.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 43111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 43111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 66822.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 66822.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 68978.54, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 50604.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 43111.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 82852.15 } ] } ] }, { "description": "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOUS TISSUE - SOI : 1", "code_information": [ { "code": "3841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4735.47, "maximum": 5066.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4735.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5066.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4735.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4735.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 3", "code_information": [ { "code": "0423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10008.4, "maximum": 10708.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10008.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10708.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10008.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10008.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 4", "code_information": [ { "code": "1794", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54992.69, "maximum": 58842.18, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 54992.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 58842.18, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54992.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54992.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22594.97, "maximum": 24176.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 22594.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24176.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22594.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22594.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY BYPASS WO AMI OR COMPLEX PDX - SOI : 2", "code_information": [ { "code": "1662", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33063.46, "maximum": 35377.9, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 33063.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 35377.9, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33063.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33063.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH CC", "code_information": [ { "code": "158", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8969, "minimum": 8969.91, "maximum": 32264.292, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13461.07 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9059.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11660.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16253.48, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13096.07, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12611.69, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9508.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13903.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13903.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14351.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9720.87 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8969.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17425.2 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC", "code_information": [ { "code": "056", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22237, "minimum": 22237.37, "maximum": 46390.0151, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34337.54 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 22459.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 28908.58, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 40294.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 32466.56, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 31265.74, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23571.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 34467.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 34467.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 35579.79, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28659.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 22237.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46390.02 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC", "code_information": [ { "code": "024", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 37152, "minimum": 17550, "maximum": 70428.8648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54343.4 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 37152.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 37523.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48298.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 67320.06, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 54242.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 52236.2, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 37152.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 39381.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 37152.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 37152.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 57586.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 57586.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 59443.76, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 46172.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 37152.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 70428.86 } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC", "code_information": [ { "code": "324", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30009, "minimum": 10350, "maximum": 63753.9342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42579.13 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 30009.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 30309.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39012.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 54376.94, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43813.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 42193.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 30009.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 31809.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 30009.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30009.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 46514.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 46514.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 48014.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47222.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30009.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 59191.22 } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 3", "code_information": [ { "code": "1143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6926.69, "maximum": 7411.56, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6926.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7411.56, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6926.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6926.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITHOUT CCMCC", "code_information": [ { "code": "159", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7080, "minimum": 6903.03, "maximum": 24469.2186, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9684.51 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7150.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9204.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12829.3, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10337.08, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9954.75, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7505, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10974.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10974.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11328.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6903.03 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7080.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12219.5 } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 1", "code_information": [ { "code": "0451", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6539.76, "maximum": 6997.54, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6539.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6997.54, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6539.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6539.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE", "code_information": [ { "code": "325", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30566, "minimum": 12150, "maximum": 55387.3496, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 37927.64 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 30566.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 30872.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39737.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 55387.35, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44627.78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 42977.16, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 30566.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 32401.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 30566.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30566.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 47378.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 47378.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 48907.15, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30566.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 37629.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30567, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 53022.19 } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 1", "code_information": [ { "code": "1141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3289.49, "maximum": 3519.75, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3289.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3519.75, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3289.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3289.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 4", "code_information": [ { "code": "0454", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16939.34, "maximum": 18125.09, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16939.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18125.09, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16939.34, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16939.34, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 4", "code_information": [ { "code": "1144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15815.63, "maximum": 16922.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15815.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16922.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15815.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15815.63, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "074", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10105, "minimum": 10105.8, "maximum": 19311.1105, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14718.96 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10105.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10206.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13137.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18311.73, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14754.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14208.77, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10105.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10712.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10105.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10105.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 15664.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 15664.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16169.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11098.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10105.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19311.11 } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 2", "code_information": [ { "code": "1312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12532.5, "maximum": 13409.78, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12532.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13409.78, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12532.5, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12532.5, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "027", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24113, "minimum": 7200, "maximum": 45717.5349, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34895.5 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 24113.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 24354.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 31346.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 43692.77, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35204.99, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33902.89, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 24113.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 25559.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 24113.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24113.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 37375.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 37375.17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 38580.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24113.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33585.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 24113, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45717.53 } ] } ] }, { "description": "CYSTOURETERO WLITHOTRIPSY", "code_information": [ { "code": "52356", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26250, "discounted_cash": 6862, "minimum": 354.06, "maximum": 26250, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8768.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10293.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6930.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9607.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10019.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9648.49, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 378.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7274.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10636.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10636.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9040.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 26250, "discounted_cash": 6862, "minimum": 354.06, "maximum": 26250, "payers_information": [ { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9040.14, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8768.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10293.56, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6930.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9607.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10019.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9648.49, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 378.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7274.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 354.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6862.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10636.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10636.67, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22650.1, "maximum": 24235.61, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 22650.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24235.61, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22650.1, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22650.1, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CCMCC", "code_information": [ { "code": "744", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19665, "minimum": 14540.6625, "maximum": 36199.0693, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26999.58 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 19665.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19861.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 25564.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 35633.31, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28711.16, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 27649.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 19665.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20845.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 19665.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19665.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 30481.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 30481.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 31464.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18055.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 19665.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 36199.07 } ] } ] }, { "description": "CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR", "code_information": [ { "code": "023", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54222, "minimum": 32850, "maximum": 105690.5375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 81308.55 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 54222.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 54764.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 70489.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 98251.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 79165.17, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 76237.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 54222.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 57476.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 54222.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54222.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 84045.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 84045.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 86756.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 74970.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 54222.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 105690.54 } ] } ] }, { "description": "CVA & PRECEREBRAL OCCLUSION W INFARCT - SOI : 2", "code_information": [ { "code": "0452", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8072.66, "maximum": 8637.75, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8072.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8637.75, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8072.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8072.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 2", "code_information": [ { "code": "4202", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5392.73, "maximum": 5770.22, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5392.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5770.22, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5392.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5392.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 2", "code_information": [ { "code": "1792", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33373.01, "maximum": 35709.12, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 33373.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 35709.12, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33373.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33373.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 1", "code_information": [ { "code": "4201", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4059.12, "maximum": 4343.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4059.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4343.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4059.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4059.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITH MCC", "code_information": [ { "code": "637", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13916, "minimum": 11456.1246, "maximum": 26978.8662, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20787.56 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13916.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14055.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18091.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 25216.21, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20317.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19566.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13916.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14751.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13916.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13916.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21570.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21570.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22265.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12666.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13916.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26978.87 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 2", "code_information": [ { "code": "0422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7420.7, "maximum": 7940.15, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7420.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7940.15, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7420.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7420.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 1", "code_information": [ { "code": "1311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7099.49, "maximum": 7596.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7099.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7596.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7099.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7099.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITH CC", "code_information": [ { "code": "638", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8842, "minimum": 7501.19, "maximum": 16991.7023, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12900.24 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8930.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11494.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16022.14, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12909.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12432.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9372.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13705.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13705.47, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14147.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7501.19 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8842.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16991.7 } ] } ] }, { "description": "Diag laparo separate proc", "code_information": [ { "code": "49320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8200, "discounted_cash": 7737, "minimum": 335.91, "maximum": 8200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7814.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 359.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "131.74% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8200, "discounted_cash": 7737, "minimum": 335.91, "maximum": 8200, "payers_information": [ { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7814.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 359.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 335.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7737.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8200, "additional_payer_notes": "127.78% of Medicare Rates" } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC", "code_information": [ { "code": "057", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12591, "minimum": 12591.6, "maximum": 24720.5927, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19552.61 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12591.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12717.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16369.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22816.05, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18383.79, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17703.85, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12591.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13347.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12591.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12591.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19517.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19517.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20146.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19138.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12591.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24720.59 } ] } ] }, { "description": "CYSTIC FIBROSIS - PULMONARY DISEASE - SOI : 4", "code_information": [ { "code": "1314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18877.2, "maximum": 20198.6, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18877.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20198.6, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18877.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18877.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 4", "code_information": [ { "code": "2404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15872.88, "maximum": 16983.98, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15872.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16983.98, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15872.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15872.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL DISEASES AND DISORDERS - SOI : 2", "code_information": [ { "code": "1142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4606.13, "maximum": 4928.56, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4606.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4928.56, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4606.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4606.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CCMCC", "code_information": [ { "code": "745", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11107, "minimum": 5152.4, "maximum": 22205.3493, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14858.09 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11107.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11218.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14439.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20126.72, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16216.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15617.09, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11107.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11773.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11107.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11107.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17216.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17216.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17771.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5152.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11107.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18985.06 } ] } ] }, { "description": "DEPRESSIVE NEUROSES", "code_information": [ { "code": "881", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9261, "minimum": 5434.3, "maximum": 18000, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13002.08 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9354.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12040.43, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16782.51, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13522.33, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13022.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9817.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14355.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14355.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14818.99, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5434.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9261.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16934.27 } ] } ] }, { "description": "DEEP VEIN THROMBOPHLEBITIS WITH CCMCC", "code_information": [ { "code": "294", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8104.422, "maximum": 22749.4663, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15687.12 }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16145.4 }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22749.47 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 1", "code_information": [ { "code": "2401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5584.61, "maximum": 5975.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5584.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5584.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5584.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC", "code_information": [ { "code": "442", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9490, "minimum": 9490.92, "maximum": 17899.4579, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13647.52 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9585.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12338.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17197.55, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13856.74, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13344.23, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10060.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14710.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14710.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15185.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11046.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9490.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17899.46 } ] } ] }, { "description": "DEFIBRILLATOR IMPLANTS- SOI : 3", "code_information": [ { "code": "1793", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 40597.59, "maximum": 43439.42, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 40597.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 43439.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 40597.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 40597.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH CC", "code_information": [ { "code": "375", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11784, "minimum": 11784.3, "maximum": 22762.4342, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17187.42 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11784.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11902.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 15319.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21353.17, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17205.09, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16568.74, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11784.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12491.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11784.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11784.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 18265.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 18265.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18854.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13592.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11784.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22762.43 } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC", "code_information": [ { "code": "441", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17276, "minimum": 17276.98, "maximum": 35020.8396, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26222.18 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17276.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17449.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22460.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31305.89, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25224.39, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 24291.43, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17276.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18313.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17276.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17276.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 26779.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 26779.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 27643.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17276.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 21421 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17277, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35020.84 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 1", "code_information": [ { "code": "0421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5906.88, "maximum": 6320.36, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5906.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6320.36, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5906.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5906.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 2", "code_information": [ { "code": "5172", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8522.14, "maximum": 9118.69, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8522.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9118.69, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8522.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8522.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CCMCC", "code_information": [ { "code": "443", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6997, "minimum": 6997.58, "maximum": 13017.956, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10251.07 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7067.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9096.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12679.61, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10216.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 9838.6, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7417.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 10846.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 10846.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11196.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7113.87 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6997.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13017.96 } ] } ] }, { "description": "DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS - SOI : 4", "code_information": [ { "code": "0424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18420.3, "maximum": 19709.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18420.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19709.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18420.3, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 2", "code_information": [ { "code": "2822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5998.05, "maximum": 6417.91, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5998.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6417.91, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5998.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5998.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DENTAL AND ORAL DISEASES WITH MCC", "code_information": [ { "code": "157", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16545, "minimum": 16545.69, "maximum": 57290.8494, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24483.79 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16545.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16711.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21509.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29980.79, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24156.71, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 23263.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16545.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17538.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16545.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16545.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 25645.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 25645.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 26473.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19144.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16545.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30335.71 } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 3", "code_information": [ { "code": "2843", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9985.08, "maximum": 10684.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9985.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10684.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9985.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9985.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC", "code_information": [ { "code": "439", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8325, "minimum": 8325.92, "maximum": 15935.7418, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12266.28 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8409.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10823.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15086.57, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12155.84, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11706.24, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8825.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12905.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12905.18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13321.47, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9026.77 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8325.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15935.74 } ] } ] }, { "description": "DIABETES - SOI : 3", "code_information": [ { "code": "4203", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7786.43, "maximum": 8331.48, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7786.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8331.48, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7786.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7786.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 1", "code_information": [ { "code": "2821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4490.58, "maximum": 4804.92, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4490.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4490.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4490.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4804.92, "additional_payer_notes": "107% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "440", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6262, "minimum": 6262.54, "maximum": 11395.1113, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8829.66 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6325.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8141.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11347.72, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9143.31, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8805.13, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6638.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9706.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9706.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10020.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6784.59 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6262.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11395.11 } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 2", "code_information": [ { "code": "2402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7210.8, "maximum": 7715.56, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7210.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7715.56, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7210.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7210.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC", "code_information": [ { "code": "438", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15732, "minimum": 15732.7, "maximum": 30821.0806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23935.88 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15732.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15890.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20452.54, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28507.69, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22969.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22120.2, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15732.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16676.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15732.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15732.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24385.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24385.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25172.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19337.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15732.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30821.08 } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 3", "code_information": [ { "code": "7523", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7618.94, "maximum": 8152.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7618.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8152.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7618.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7618.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "376", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9106, "minimum": 9106.03, "maximum": 16500.1264, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12785.5 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9197.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11837.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16500.13, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13294.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12803.08, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9652.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14114.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14114.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14569.65, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10521.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9106.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16358.13 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH CC", "code_information": [ { "code": "445", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10702, "minimum": 10405.5, "maximum": 20091.0392, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15588.15 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10702.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10809.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13913.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19393.58, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15626.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 15048.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10702.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11345.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10702.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10702.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 16589.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 16589.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 17124.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10405.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10702.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20091.04 } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3033", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 49432.46, "maximum": 52892.73, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 49432.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 52892.73, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 49432.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 49432.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 4", "code_information": [ { "code": "2444", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15668.28, "maximum": 16765.06, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15668.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16765.06, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15668.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15668.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 2", "code_information": [ { "code": "7702", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3378.54, "maximum": 3615.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3378.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3615.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3378.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3378.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 3", "code_information": [ { "code": "5173", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12821.91, "maximum": 13719.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12821.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13719.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12821.91, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12821.91, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES - SOI : 4", "code_information": [ { "code": "4204", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14323.01, "maximum": 15325.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14323.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15325.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14323.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14323.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CCMCC", "code_information": [ { "code": "148", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7911, "minimum": 7911.93, "maximum": 14833.4671, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12761.12 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7991.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10285.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14336.42, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11551.42, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11124.17, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8386.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12263.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12263.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12659.09, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10527.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7911.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14833.47 } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 4", "code_information": [ { "code": "5174", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21946.19, "maximum": 23482.42, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21946.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23482.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21946.19, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21946.19, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIABETES WITHOUT CCMCC", "code_information": [ { "code": "639", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6260, "minimum": 5431.94, "maximum": 17072.9748, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11344.32, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9140.56, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8802.49, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6636.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9704.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9704.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10017.06, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5431.94 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11608.16 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8928.63 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6323.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6260.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8138.86, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 4", "code_information": [ { "code": "1104", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17487.41, "maximum": 18711.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17487.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18711.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17487.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17487.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Dilation And Curettage", "code_information": [ { "code": "58120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8400, "discounted_cash": 4143, "minimum": 319.8, "maximum": 8400, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5294.15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6214.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4184.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 319.8 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5800.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6048.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5825.17, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4391.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 319.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6421.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6421.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 319.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4143.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5457.89, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 3", "code_information": [ { "code": "7593", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13046.65, "maximum": 13959.92, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13046.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13959.92, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13046.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13046.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3041", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21066.31, "maximum": 22540.95, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21066.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22540.95, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21066.31, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21066.31, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 4", "code_information": [ { "code": "7594", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 23951.9, "maximum": 25628.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 23951.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25628.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23951.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 23951.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3032", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 36947.67, "maximum": 39534.01, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 36947.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39534.01, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36947.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 36947.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY - SOI : 3", "code_information": [ { "code": "2403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10169.54, "maximum": 10881.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10169.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10881.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10169.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10169.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3241", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12305.64, "maximum": 13167.03, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12305.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13167.03, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12305.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12305.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIGESTIVE MALIGNANCY WITH MCC", "code_information": [ { "code": "374", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20506, "minimum": 20506.3, "maximum": 39115.0025, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30106.31 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20711.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26658.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 37157.42, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29939.2, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28831.86, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21736.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31784.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31784.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32810.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25736 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20506.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39115 } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3244", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29312.83, "maximum": 31364.73, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 29312.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31364.73, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29312.83, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29312.83, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 1", "code_information": [ { "code": "7701", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2155.18, "maximum": 2306.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2155.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2306.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2155.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 1", "code_information": [ { "code": "3261", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12205.99, "maximum": 13060.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12205.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13060.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12205.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12205.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 4", "code_information": [ { "code": "7704", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10998.54, "maximum": 11768.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10998.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11768.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10998.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10998.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 1", "code_information": [ { "code": "7521", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2817.75, "maximum": 3014.99, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 2817.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3014.99, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2817.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2817.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DILATION & CURETTAGE FOR NON-OBSTETRIC DIAGNOSES - SOI : 1", "code_information": [ { "code": "5171", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6167.66, "maximum": 6599.4, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6167.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6599.4, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6167.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6167.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC", "code_information": [ { "code": "147", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12365, "minimum": 12365.4, "maximum": 23060.6968, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17725.29 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12489.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16075.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22406.1, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18053.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17385.75, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13107.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19166.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19166.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19784.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14406.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12365.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23060.7 } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 4", "code_information": [ { "code": "7524", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 33313.64, "maximum": 35645.59, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 33313.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 35645.59, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33313.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 33313.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH CC", "code_information": [ { "code": "644", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10051, "minimum": 9723.23, "maximum": 19144.3798, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15228.15 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10051.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10151.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13066.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18213.06, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14674.99, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14132.21, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10051.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10654.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10051.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10051.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 15579.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 15579.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16082.18, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9723.23 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10051.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19144.38 } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 1", "code_information": [ { "code": "1101", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6412.54, "maximum": 6861.42, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6412.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6861.42, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6412.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6412.54, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY AND IMPULSE CONTROL", "code_information": [ { "code": "883", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18887, "minimum": 12296, "maximum": 34344.6543, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26899.18 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18887.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19076.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24554.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34224.86, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27576.32, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26556.37, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18887.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20021.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18887.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18887.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29276.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29276.23, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30220.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14520.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18887.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34344.65 } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 1", "code_information": [ { "code": "2841", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5267.64, "maximum": 5636.37, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5267.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5636.37, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5267.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5267.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC", "code_information": [ { "code": "267", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45121, "minimum": 4793.51, "maximum": 87920.1957, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 69997.53 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 45121.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 45572.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 58657.91, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 81760.1, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 65877.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 63440.79, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 45121.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 47828.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 45121.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45121.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 69938.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 69938.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 72194.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4793.51 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 45121.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 87157.5 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITH MCC", "code_information": [ { "code": "643", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15881, "minimum": 13102.575, "maximum": 30702.5167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23595.95 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15881.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16040.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20646.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28778.15, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23187.69, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22330.06, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15881.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16834.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15881.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15881.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24617.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24617.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25411.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15881.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17560.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15882, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30702.52 } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 1", "code_information": [ { "code": "2441", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4359.13, "maximum": 4664.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4359.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4664.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4359.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4359.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 2", "code_information": [ { "code": "2842", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7392.08, "maximum": 7909.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7392.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7909.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7392.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7392.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 3", "code_information": [ { "code": "2443", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8730.98, "maximum": 9342.15, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8730.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9342.15, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8730.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8730.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF GALLBLADDER & BILIARY TRACT - SOI : 4", "code_information": [ { "code": "2844", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17059.13, "maximum": 18253.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17059.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18253.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17059.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17059.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 3", "code_information": [ { "code": "2823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9386.13, "maximum": 10043.16, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9386.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10043.16, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9386.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9386.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EPISTAXIS WITH MCC", "code_information": [ { "code": "150", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12928, "minimum": 9436.4106, "maximum": 25606.1175, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18854.09 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12928.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13057.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16807.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23426.71, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18875.83, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18177.68, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12928.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13704.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12928.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12928.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 20039.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 20039.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 20685.84, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18172 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12928.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25606.12 } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 2", "code_information": [ { "code": "3042", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28158.38, "maximum": 30129.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 28158.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 30129.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28158.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28158.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PANCREAS EXCEPT MALIGNANCY - SOI : 4", "code_information": [ { "code": "2824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 20005.15, "maximum": 21405.51, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 20005.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21405.51, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20005.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20005.15, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EPISTAXIS WITHOUT MCC", "code_information": [ { "code": "151", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7319, "minimum": 5898.61, "maximum": 19986.2205, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11345.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11345.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11711.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5898.61 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14042.42 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11054.28 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7392.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9515.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13263.08, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10686.59, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10291.33, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7758.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7319.58, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 3", "code_information": [ { "code": "3043", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38877.05, "maximum": 41598.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 38877.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 41598.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38877.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38877.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF PERSONALITY & IMPULSE CONTROL - SOI : 2", "code_information": [ { "code": "7522", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3671.13, "maximum": 3928.11, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3671.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3928.11, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3671.13, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3671.13, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC", "code_information": [ { "code": "146", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 20306, "minimum": 9607.7028, "maximum": 42499.634, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30278.43 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 20306.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 20509.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 26398.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36795.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 29647.27, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 28550.73, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 20306.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21524.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 20306.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20306.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 31474.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 31474.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 32490.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16883.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 20306.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42499.63 } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITH MCC", "code_information": [ { "code": "444", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16114, "minimum": 15861.1, "maximum": 31204.5611, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23425.27 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16275.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20949.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29200.02, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23527.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22657.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17081.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24977.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24977.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25783.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15861.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16114.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 31204.56 } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC", "code_information": [ { "code": "391", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12335, "minimum": 12267.5, "maximum": 23796.164, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18297.59 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12458.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16035.97, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22351.67, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18009.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17343.52, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13075.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19119.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19119.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19736.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12267.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12335.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23796.16 } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 3", "code_information": [ { "code": "1103", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10282.97, "maximum": 11002.78, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10282.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11002.78, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10282.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10282.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DISORDERS OF THE BILIARY TRACT WITHOUT CCMCC", "code_information": [ { "code": "446", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8195, "minimum": 7933.52, "maximum": 14850.1373, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11496.05 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8277.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10654.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14850.14, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11965.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11522.79, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8687.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12702.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12702.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 13112.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7933.52 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8195.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14770.48 } ] } ] }, { "description": "EATING DISORDERS - SOI : 1", "code_information": [ { "code": "7591", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6174.02, "maximum": 6606.2, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6174.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6606.2, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6174.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6174.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DIVERTICULITIS & DIVERTICULOSIS - SOI : 2", "code_information": [ { "code": "2442", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5831.61, "maximum": 6239.82, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5831.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6239.82, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5831.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5831.61, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Exc Hand Les Sc < 1.5 Cm", "code_information": [ { "code": "26115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18375, "discounted_cash": 2113, "minimum": 255.27, "maximum": 18375, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2701.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3170.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2134.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 255.27 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2959.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3086.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2972.03, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 273.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2240.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 255.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 3276.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 3276.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 255.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2113.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2784.64, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "EATING DISORDERS - SOI : 2", "code_information": [ { "code": "7592", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8406.59, "maximum": 8995.05, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8406.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8995.05, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8406.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8406.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 1", "code_information": [ { "code": "8411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15021.62, "maximum": 16073.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15021.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16073.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15021.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15021.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES", "code_information": [ { "code": "003", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 199682, "minimum": 108450, "maximum": 397033.7633, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 305800.67 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 199682.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 201678.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 259586.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 361824.27, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 291536.11, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 280753.27, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 199682.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 211662.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 199682.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 199682.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 309507.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 309507.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 319491.63, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 199682.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 306235 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 199682, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 397033.76 } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3044", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54426.59, "maximum": 58236.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 54426.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 58236.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54426.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54426.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 4", "code_information": [ { "code": "8414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 173017.86, "maximum": 185129.11, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 173017.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 185129.11, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 173017.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 173017.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3242", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13814.16, "maximum": 14781.15, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13814.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14781.15, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13814.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13814.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 1", "code_information": [ { "code": "3031", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 32600.2, "maximum": 34882.21, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 32600.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 34882.21, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 32600.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 32600.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 4", "code_information": [ { "code": "9114", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 54718.12, "maximum": 58548.39, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 54718.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 58548.39, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54718.12, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 54718.12, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 3", "code_information": [ { "code": "8413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 52320.18, "maximum": 55982.59, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 52320.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55982.59, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 52320.18, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 52320.18, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 4", "code_information": [ { "code": "3264", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25927.93, "maximum": 27742.89, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25927.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27742.89, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25927.93, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25927.93, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK - SOI : 4", "code_information": [ { "code": "3034", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 74045.86, "maximum": 79229.07, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 74045.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 79229.07, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 74045.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 74045.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT", "code_information": [ { "code": "933", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 36986, "minimum": 11700, "maximum": 80158.5225, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 43488.49 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 36986.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 37356.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 48082.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 67018.98, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53999.84, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 52002.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 36986.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 39205.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 36986.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 36986.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 57328.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 57328.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 59177.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 56888.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 36986.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 80158.52 } ] } ] }, { "description": "EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT", "code_information": [ { "code": "927", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 200858, "minimum": 91688.6241, "maximum": 439479.673, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 378067.29 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 200858.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 202867.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 261116.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 363955.67, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 293253.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 282407.11, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 200858.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 212910.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 200858.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 200858.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 311330.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 311330.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 321373.66, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 200858.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 311896 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 200859, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 439479.67 } ] } ] }, { "description": "ENDOCRINE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "645", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7641, "minimum": 6099.97, "maximum": 60097.9962, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10913.71 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7717.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9934.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13846.52, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11156.69, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10744.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8100.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11844.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11844.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12226.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6099.97 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7641.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14425.9 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 1", "code_information": [ { "code": "9501", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12415.89, "maximum": 13285, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12415.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13285, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12415.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12415.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 2", "code_information": [ { "code": "9502", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16736.86, "maximum": 17908.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16736.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17908.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16736.86, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16736.86, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC", "code_information": [ { "code": "266", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 57959, "minimum": 11700, "maximum": 110983.3083, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 89588.87 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 57959.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 58539.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 75347.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 105023.38, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 84621.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 81491.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 57959.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 61437.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 57959.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 57959.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 89837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 89837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 92735.87, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 49753.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 57959.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 110983.31 } ] } ] }, { "description": "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVICE - SOI : 3", "code_information": [ { "code": "7703", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5481.78, "maximum": 5865.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5481.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5865.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5481.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5481.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 2", "code_information": [ { "code": "7922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15308.9, "maximum": 16380.52, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15308.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16380.52, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15308.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15308.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 4", "code_information": [ { "code": "9504", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 44744.7, "maximum": 47876.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 44744.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 47876.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 44744.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 44744.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "DYSEQUILIBRIUM", "code_information": [ { "code": "149", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7484, "minimum": 7484.8, "maximum": 15112.0626, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10681.36 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7559.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 9730.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13562.46, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10927.81, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10523.63, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7933.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 11601.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 11601.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 11975.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9096.66 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7484.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13847.9 } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 3", "code_information": [ { "code": "1783", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 53704.67, "maximum": 57464, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 53704.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 57464, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 53704.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 53704.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 1", "code_information": [ { "code": "7921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12017.29, "maximum": 12858.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12017.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12858.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12017.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12017.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EAR, NOSE, MOUTH, THROAT, CRANIALFACIAL MALIGNANCIES - SOI : 2", "code_information": [ { "code": "1102", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6936.23, "maximum": 7421.77, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6936.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7421.77, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6936.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6936.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 2", "code_information": [ { "code": "0092", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 60423.58, "maximum": 64653.23, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 60423.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 64653.23, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 60423.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 60423.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 4", "code_information": [ { "code": "7924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 38747.72, "maximum": 41460.06, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 38747.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 41460.06, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38747.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 38747.72, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE HIP JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3243", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 19651.07, "maximum": 21026.64, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 19651.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21026.64, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19651.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19651.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "039", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11464, "minimum": 5400, "maximum": 21085.8652, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16365.56 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 11464.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 11578.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 14903.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 20773.11, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 16737.72, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 16118.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 11464.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12152.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 11464.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11464.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 17769.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 17769.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 18342.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19392 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 11464.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21085.87 } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 1", "code_information": [ { "code": "8431", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4519.21, "maximum": 4835.55, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4519.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4835.55, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4519.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4519.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 2", "code_information": [ { "code": "3262", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 12960.78, "maximum": 13868.03, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 12960.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13868.03, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12960.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12960.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 1", "code_information": [ { "code": "0921", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11178.75, "maximum": 11961.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11178.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11961.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11178.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11178.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 1", "code_information": [ { "code": "1781", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39720.89, "maximum": 42501.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 39720.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42501.35, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39720.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39720.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ELECTIVE KNEE JOINT REPLACEMENT- SOI : 3", "code_information": [ { "code": "3263", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18607.94, "maximum": 19910.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18607.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19910.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18607.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18607.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 2", "code_information": [ { "code": "0922", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14154.46, "maximum": 15145.27, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14154.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15145.27, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14154.46, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14154.46, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 2", "code_information": [ { "code": "1782", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 43293.42, "maximum": 46323.96, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 43293.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 46323.96, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 43293.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 43293.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 3", "code_information": [ { "code": "5313", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8474.44, "maximum": 9067.65, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8474.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9067.65, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8474.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8474.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 3", "code_information": [ { "code": "0093", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 110110.47, "maximum": 117818.2, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 110110.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 117818.2, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 110110.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 110110.47, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES", "code_information": [ { "code": "748", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13452, "minimum": 6300, "maximum": 32821.6308, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20150.72 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13452.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13587.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17488.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24375.89, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19640.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 18914.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13452.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14259.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13452.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13452.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 20851.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 20851.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 21523.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22840 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13452.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25237.46 } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 1", "code_information": [ { "code": "0821", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4419.56, "maximum": 4728.93, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4419.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4728.93, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4419.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4419.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 3", "code_information": [ { "code": "5143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15285.58, "maximum": 16355.57, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15285.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16355.57, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15285.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15285.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 2", "code_information": [ { "code": "0822", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5772.24, "maximum": 6176.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5772.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6176.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5772.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5772.24, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS", "code_information": [ { "code": "864", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8762, "minimum": 7481.05, "maximum": 19152.7689, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12662.15 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8850.07, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11391.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15877.56, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12793.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12320, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9288.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13581.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13581.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14019.92, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7481.05 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8762.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16636.01 } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 2", "code_information": [ { "code": "7222", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4749.25, "maximum": 5081.7, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4749.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5081.7, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4749.25, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4749.25, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 1", "code_information": [ { "code": "5311", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4150.29, "maximum": 4440.81, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4150.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4440.81, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4150.29, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4150.29, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE 3RD DEGREE BURNS W SKIN GRAFT - SOI : 2", "code_information": [ { "code": "8412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27312.42, "maximum": 29224.29, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 27312.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29224.29, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27312.42, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27312.42, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 3", "code_information": [ { "code": "7223", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6444.35, "maximum": 6895.45, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6444.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6895.45, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6444.35, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6444.35, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 2", "code_information": [ { "code": "5312", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5424.53, "maximum": 5804.25, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5424.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5804.25, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5424.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5424.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 1", "code_information": [ { "code": "9111", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15548.49, "maximum": 16636.88, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15548.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16636.88, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15548.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15548.49, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "505", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17259, "minimum": 16982.8, "maximum": 32512.4701, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24465.15 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17259.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17431.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22436.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31273.56, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25198.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 24266.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17259.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18294.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17259.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17259.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 26751.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 26751.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 27614.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16982.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17259.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32512.47 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 1", "code_information": [ { "code": "5301", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4830.88, "maximum": 5169.04, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4830.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5169.04, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4830.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4830.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 3", "code_information": [ { "code": "9113", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 29241.8, "maximum": 31288.73, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 29241.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31288.73, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29241.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29241.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC", "code_information": [ { "code": "392", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7747, "minimum": 7638.59, "maximum": 14455.5444, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11268 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7825.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10071.95, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14038.74, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11311.57, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 10893.2, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8212.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12008.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12008.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12396.24, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7638.59 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7747.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14455.54 } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 2", "code_information": [ { "code": "3412", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5488.14, "maximum": 5872.31, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5488.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5872.31, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5488.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5488.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 2", "code_information": [ { "code": "5302", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6392.4, "maximum": 6839.87, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6392.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6839.87, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6392.4, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6392.4, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC", "code_information": [ { "code": "981", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 44473, "minimum": 31427.0055, "maximum": 88068.9639, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67992.35 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 44473.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 44918.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 57815.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 80586.38, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 64931.63, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 62530.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 44473.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 47142.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 44473.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 44473.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 68934.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 68934.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 71157.95, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 66303.7 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 44473.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 88068.96 } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC", "code_information": [ { "code": "562", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13804, "minimum": 11447.1765, "maximum": 27112.2507, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21811.65 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 13804.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 13942.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 17945.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 25013.77, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20154.58, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 19409.14, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 13804.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14632.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 13804.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13804.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 21396.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 21396.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22087.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15413.4 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 13804.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27112.25 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 1", "code_information": [ { "code": "5141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7944.39, "maximum": 8500.5, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7944.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8500.5, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7944.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7944.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT - SOI : 3", "code_information": [ { "code": "7923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 22449.74, "maximum": 24021.22, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 22449.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24021.22, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22449.74, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22449.74, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 3", "code_information": [ { "code": "3423", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8404.47, "maximum": 8992.78, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8992.78, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8404.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8404.47, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8404.47 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 4", "code_information": [ { "code": "5144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 28211.38, "maximum": 30186.18, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 28211.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 30186.18, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28211.38, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 28211.38, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 3", "code_information": [ { "code": "8433", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11688.66, "maximum": 12506.87, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11688.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12506.87, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11688.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11688.66, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES OF FEMUR WITHOUT MCC", "code_information": [ { "code": "534", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7996, "minimum": 6149.72, "maximum": 16387.806, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11617.97 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8076.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10395.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14489.51, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11674.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11242.97, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8476.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12394.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12394.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12794.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6149.72 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7996.42, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15079.86 } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 1", "code_information": [ { "code": "7221", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 3387.02, "maximum": 3624.11, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 3387.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3624.11, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3387.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3387.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 4", "code_information": [ { "code": "8434", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 16967.96, "maximum": 18155.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 16967.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18155.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16967.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16967.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE ABDOMINALTHORACIC PROCEDURES FOR MULT SIGNIFICANT TRAUMA - SOI : 2", "code_information": [ { "code": "9112", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 18876.14, "maximum": 20197.47, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 18876.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 20197.47, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18876.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18876.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITH MCC", "code_information": [ { "code": "535", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12463, "minimum": 10323.5508, "maximum": 24637.2274, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18598.79 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 12463.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 12588.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 16203.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22584.71, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18197.4, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 17524.34, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 12463.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13211.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 12463.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12463.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 19319.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 19319.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 19942.35, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12463.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 17485 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 12464, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24637.23 } ] } ] }, { "description": "EXTERNAL HEART ASSIST SYSTEMS- SOI : 4", "code_information": [ { "code": "1784", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 66228.69, "maximum": 70864.7, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 66228.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 70864.7, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66228.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66228.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS- SOI : 3", "code_information": [ { "code": "9503", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 26055.14, "maximum": 27879, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 26055.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27879, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26055.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26055.14, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 1", "code_information": [ { "code": "2321", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9808.05, "maximum": 10494.61, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9808.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10494.61, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9808.05, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9808.05, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 1", "code_information": [ { "code": "0091", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 48887.57, "maximum": 52309.7, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 48887.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 52309.7, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48887.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 48887.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC", "code_information": [ { "code": "982", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23508, "minimum": 18450, "maximum": 45356.2852, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35657.12 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 23508.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 23743.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 30560.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42597.31, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 34322.34, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 33052.88, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 23508.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24919.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 23508.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23508.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 36438.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 36438.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 37613.52, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 28154.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 23508.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45356.29 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH CC", "code_information": [ { "code": "378", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9635, "minimum": 9635.49, "maximum": 18264.4127, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14110.81 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 9731.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 12526.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17459.51, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14067.82, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 13547.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10213.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 14935.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 14935.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 15416.78, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10359.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 9635.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18264.41 } ] } ] }, { "description": "EXTRAOCULAR PROCEDURES EXCEPT ORBIT", "code_information": [ { "code": "115", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14838, "minimum": 14838.09, "maximum": 28362.7303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22438.46 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 14838.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14986.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19289.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26886.62, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21663.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20862.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 14838.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15728.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 14838.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14838.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 22999.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 22999.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 23740.94, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 27580.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14838.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28362.73 } ] } ] }, { "description": "EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CCMCC", "code_information": [ { "code": "983", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16519, "minimum": 9000, "maximum": 43825.2372, "payers_information": [ { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 16684.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 21475.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29933.15, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 24118.32, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 23226.28, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17510.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 25605.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 25605.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 26431.04, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 15042.6 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30904.45 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23453.95 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 16519.4, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 4", "code_information": [ { "code": "2464", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 13256.55, "maximum": 14184.51, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 13256.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14184.51, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13256.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13256.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE", "code_information": [ { "code": "790", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 56224, "minimum": 8699.86, "maximum": 110131.1296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 86060.45 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 56224.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 56786.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 73091.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 101878.16, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 82087.26, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 79051.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 56224.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 59597.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 56224.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 56224.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 87147.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 87147.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 89958.64, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8699.86 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 56224.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 110131.13 } ] } ] }, { "description": "EXTENSIVE THIRD DEGREE BURNS WITHOUT SKIN GRAFT- SOI : 2", "code_information": [ { "code": "8432", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5940.8, "maximum": 6356.66, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5940.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6356.66, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5940.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5940.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 1", "code_information": [ { "code": "3141", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8097.04, "maximum": 8663.83, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8097.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8663.83, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8097.04, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8097.04, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 3", "code_information": [ { "code": "0823", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8121.43, "maximum": 8689.93, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8121.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8689.93, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8121.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8121.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACORPOREAL MEMBRANE OXYGENATION (ECMO)- SOI : 4", "code_information": [ { "code": "0094", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 194638.6, "maximum": 208263.3, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 194638.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 208263.3, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 194638.6, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 194638.6, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EYE INFECTIONS AND OTHER EYE DISORDERS - SOI : 4", "code_information": [ { "code": "0824", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14031.48, "maximum": 15013.68, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14031.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15013.68, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14031.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14031.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH CC", "code_information": [ { "code": "038", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15661, "minimum": 8550, "maximum": 29850.338, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22947.64 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15661.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15818.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 20359.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28378.42, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22865.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 22019.9, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15661.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16601.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15661.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15661.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 24275.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 24275.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 25058.21, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23733 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15661.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 29850.34 } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 1", "code_information": [ { "code": "3411", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4419.56, "maximum": 4728.93, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4419.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4728.93, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4419.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4419.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 3", "code_information": [ { "code": "0923", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 21195.64, "maximum": 22679.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 21195.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 22679.33, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21195.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21195.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "EXTRACRANIAL PROCEDURES WITH MCC", "code_information": [ { "code": "037", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 31333, "minimum": 22050, "maximum": 61521.7447, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48416.8 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 31333.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 31647.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 40734.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 56777.08, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 45747.54, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 44055.51, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 31333.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 33213.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 31333.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 31333.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 48567.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 48567.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 50134.29, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 53977.1 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 31333.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 61521.74 } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 1", "code_information": [ { "code": "3421", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4320.97, "maximum": 4623.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4320.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4623.44, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4320.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4320.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM INFECTIONS - SOI : 4", "code_information": [ { "code": "5314", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15745.67, "maximum": 16847.87, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15745.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16847.87, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15745.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15745.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FACIAL BONE PROCEDURES EXCEPT MAJOR CRANIALFACIAL BONE PROCEDURES - SOI : 4", "code_information": [ { "code": "0924", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 39182.36, "maximum": 41925.13, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 39182.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 41925.13, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39182.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 39182.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 3", "code_information": [ { "code": "3163", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14722.67, "maximum": 15753.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14722.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15753.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14722.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14722.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 2", "code_information": [ { "code": "3422", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5791.33, "maximum": 6196.72, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5791.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6196.72, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5791.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5791.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 3", "code_information": [ { "code": "5303", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9625.71, "maximum": 10299.51, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9625.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10299.51, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9625.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9625.71, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FEVER AND INFLAMMATORY CONDITIONS- SOI : 4", "code_information": [ { "code": "7224", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8918.62, "maximum": 9542.92, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8918.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9542.92, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8918.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8918.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 4", "code_information": [ { "code": "3164", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 24919.77, "maximum": 26664.15, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 24919.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 26664.15, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24919.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24919.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES OF HIP AND PELVIS WITHOUT MCC", "code_information": [ { "code": "536", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8010, "minimum": 7548.57, "maximum": 15022.4285, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11289.51 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8090.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10413.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14515.03, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11695.33, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11262.76, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8491.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12416.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12416.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12816.8, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7548.57 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8010.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15022.43 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM MALIGNANCY - SOI : 4", "code_information": [ { "code": "5304", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14427.96, "maximum": 15437.92, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14427.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15437.92, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14427.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14427.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FULL TERM NEONATE WITH MAJOR PROBLEMS", "code_information": [ { "code": "793", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 39571, "minimum": 14311.5, "maximum": 77261.1149, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 60374.7 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 39571.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 39967.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 51442.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 71703.61, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 57774.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 55637.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 39571.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 41945.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 39571.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 39571.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 61335.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 61335.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 63314.45, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 54832.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 39571.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 77261.11 } ] } ] }, { "description": "FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES - SOI : 2", "code_information": [ { "code": "5142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11619.76, "maximum": 12433.14, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11619.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12433.14, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11619.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11619.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY", "code_information": [ { "code": "934", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21181, "minimum": 4311.43, "maximum": 39752.284, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 30013.08 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 21181.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 21393.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 27535.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 38380.46, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30924.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 29780.87, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 21181.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22452.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 21181.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21181.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 32830.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 32830.97, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 33890.03, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4311.43 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 21181.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 39752.28 } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 2", "code_information": [ { "code": "3142", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 10597.82, "maximum": 11339.67, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 10597.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11339.67, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10597.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10597.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 3", "code_information": [ { "code": "2323", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 17865.87, "maximum": 19116.48, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 17865.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19116.48, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17865.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17865.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH MCC", "code_information": [ { "code": "503", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 26630, "minimum": 26630.76, "maximum": 49029.9165, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 38466.94 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 26630.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 26897.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 34619.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 48254.94, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 38880.91, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 37442.85, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 26630.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 28228.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 26630.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 26630.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 41277.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 41277.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 42609.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34795.9 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 26630.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 49029.92 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITH MCC", "code_information": [ { "code": "377", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17589, "minimum": 17589.58, "maximum": 33683.2896, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 25678.58 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17589.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 17765.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 22866.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31872.32, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25680.79, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 24730.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17589.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18644.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17589.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17589.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27263.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27263.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28143.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20066 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17589.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 33683.29 } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 1", "code_information": [ { "code": "3401", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 4081.39, "maximum": 4367.09, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 4081.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4367.09, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4081.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4081.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 2", "code_information": [ { "code": "3402", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5213.57, "maximum": 5578.52, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5213.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5578.52, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5213.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5213.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 3", "code_information": [ { "code": "3143", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15322.69, "maximum": 16395.28, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15322.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16395.28, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15322.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15322.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 4", "code_information": [ { "code": "3414", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 14089.79, "maximum": 15076.08, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 14089.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15076.08, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14089.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14089.79, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 2", "code_information": [ { "code": "3162", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9594.97, "maximum": 10266.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9594.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10266.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9594.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9594.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT & TOE PROCEDURES - SOI : 4", "code_information": [ { "code": "3144", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 25759.37, "maximum": 27562.53, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 25759.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27562.53, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25759.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25759.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK - SOI : 4", "code_information": [ { "code": "3424", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 15077.8, "maximum": 16133.25, "payers_information": [ { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15077.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 15077.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16133.25, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15077.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FOOT PROCEDURES WITH CC", "code_information": [ { "code": "504", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17976, "minimum": 17976.3, "maximum": 32573.1462, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24772.08 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 17976.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 18156.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 23369.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32573.15, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26245.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 25274.75, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 17976.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19054.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 17976.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17976.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 27863.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 27863.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 28762.16, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22545 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 17976.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 32512.47 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CCMCC", "code_information": [ { "code": "928", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 67763, "minimum": 40750.2, "maximum": 123730.7901, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 99250.43 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 67763.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 68441.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 88092.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 122787.21, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 98934.51, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 95275.28, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 67763.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 71829.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 67763.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67763.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 105033.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 105033.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 108421.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 40750.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 67763.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 123730.79 } ] } ] }, { "description": "Hc R&L Hrt Cath Chd Img Cath Trgt Zone Nml Nt Connj", "code_information": [ { "code": "93596", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14807.6, "discounted_cash": 4149, "minimum": 4132, "maximum": 14807.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5302.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6223.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4190.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5808.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6057.88, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5833.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4398.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6431.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6431.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4149.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5465.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 3", "code_information": [ { "code": "3403", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7442.96, "maximum": 7963.97, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7442.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7963.97, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7442.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7442.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF FEMUR - SOI : 4", "code_information": [ { "code": "3404", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11119.39, "maximum": 11897.75, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11119.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11897.75, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11119.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11119.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 2", "code_information": [ { "code": "2322", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 11514.81, "maximum": 12320.85, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 11514.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12320.85, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11514.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11514.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE OF PELVIS OR DISLOCATION OF HIP - SOI : 3", "code_information": [ { "code": "3413", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 8036.62, "maximum": 8599.18, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 8036.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8599.18, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8036.62, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8036.62, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTRIC FUNDOPLICATION - SOI : 4", "code_information": [ { "code": "2324", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 27793.7, "maximum": 29739.26, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 27793.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 29739.26, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27793.7, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 27793.7, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC", "code_information": [ { "code": "563", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8835, "minimum": 8711.71, "maximum": 19731.8388, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12845.74 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 8924.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 11486.37, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16010.23, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12900.08, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 12422.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9365.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 13695.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 13695.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 14137.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8711.71 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 8835.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16558.2 } ] } ] }, { "description": "GASTROINTESTINAL HEMORRHAGE WITHOUT CCMCC", "code_information": [ { "code": "379", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 6347, "minimum": 6347.02, "maximum": 11795.2648, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9082.09 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 6410.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 8251.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 11500.8, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9266.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 8923.91, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6727.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 9837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 9837.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 10155.23, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8081.57 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 6347.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11795.26 } ] } ] }, { "description": "FRACTURES OF FEMUR WITH MCC", "code_information": [ { "code": "533", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15146, "minimum": 10304.3763, "maximum": 28249.724, "payers_information": [ { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24233.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20048.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28249.72 }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23399.45 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15297.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19689.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27444.55, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22113.16, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21295.28, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16054.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15146, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 23476.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 23476.3, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH CC", "code_information": [ { "code": "389", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7843, "minimum": 6840.26, "maximum": 14850.1402, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11422.9 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 7921.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 10196.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14212.24, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11451.36, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 11027.82, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8314, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 12157.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 12157.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 12549.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6840.26 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 7843.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14850.14 } ] } ] }, { "description": "FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CCMCC", "code_information": [ { "code": "929", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 30664, "minimum": 20636.8, "maximum": 58918.8946, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 46120.46 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 30971.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 39863.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 55564.26, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44770.32, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 43114.43, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 32504.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 47530.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 47530.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 49063.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20636.8 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 30664.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 58918.89 } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITH MCC", "code_information": [ { "code": "388", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14292, "minimum": 14292.67, "maximum": 27230.8147, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20847.79 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 14292.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 14435.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 18580.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 25898.32, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20867.3, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 20095.49, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 14292.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15150.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 14292.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14292.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 22153.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 22153.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 22868.27, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14821.2 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 14292.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27230.81 } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 1", "code_information": [ { "code": "2461", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 5157.39, "maximum": 5518.41, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 5157.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5518.41, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5157.39, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5157.39, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL OBSTRUCTION WITHOUT CCMCC", "code_information": [ { "code": "390", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 5535, "minimum": 5069.49, "maximum": 10350, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8017.84 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 5591.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 7196.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 10031.12, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8082.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 7783.53, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 5868.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 8580.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 8580.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 8857.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5069.49 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 5535.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10137.22 } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 3", "code_information": [ { "code": "2463", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 9026.75, "maximum": 9658.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 9026.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9658.62, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9026.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9026.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "GASTROINTESTINAL VASCULAR INSUFFICIENCY - SOI : 2", "code_information": [ { "code": "2462", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 6330.92, "maximum": 6774.08, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 6330.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6774.08, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6330.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6330.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CCMCC", "code_information": [ { "code": "513", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15207, "minimum": 13068.0609, "maximum": 27892.1795, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23250.28 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 15207.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 15360.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 19770.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27556.82, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22203.62, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 21382.39, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 15207.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16120.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 15207.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15207.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 23572.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 23572.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 24332.74, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15207.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18406.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 15208, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27892.18 } ] } ] }, { "description": "HAND & WRIST PROCEDURES - SOI : 1", "code_information": [ { "code": "3161", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 7086.77, "maximum": 7582.84, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "case rate", "standard_charge_dollar": 7086.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7582.84, "additional_payer_notes": "107% of State Medicaid Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7086.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7086.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "HAND PROCEDURES FOR INJURIES", "code_information": [ { "code": "906", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 18869, "minimum": 14400, "maximum": 49077.7719, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 26988.11 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 18869.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 19057.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 24529.84, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34190.83, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27548.9, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 26529.97, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 18869.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20001.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 18869.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 18869.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 29247.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 29247.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 30190.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 22052.3 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 18869.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 40432.17 } ] } ] }, { "description": "HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "514", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10026, "minimum": 10026, "maximum": 40738.1427, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14938.41 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "case rate", "standard_charge_dollar": 10026.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 10126.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "case rate", "standard_charge_dollar": 13033.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18167.13, "additional_payer_notes": "181.20% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14637.97, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "case rate", "standard_charge_dollar": 14096.57, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "case rate", "standard_charge_dollar": 10026.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10627.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "case rate", "standard_charge_dollar": 10026.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10026.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "case rate", "standard_charge_dollar": 15540.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "case rate", "standard_charge_dollar": 15540.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "NATIONAL HEALTHCARE SOLUTIONS, INC (NHSI)", "plan_name": "NATIONAL HEALTHCARE SOLUTIONS, INC Commercial", "methodology": "case rate", "standard_charge_dollar": 16041.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10026.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11535.5 }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "case rate", "standard_charge_dollar": 10026, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 18888.73 } ] } ] }, { "description": "Hc Vnpnxr 3 Years/> Phys/Qhp Skill", "code_information": [ { "code": "36410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 305.44, "minimum": 15.49, "maximum": 305.44, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.57 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.49 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - 93307 - 48300011", "code_information": [ { "code": "93307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3128.92, "discounted_cash": 305, "minimum": 129.18, "maximum": 3128.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 390.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 458.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 308.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 129.18 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 427.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 445.85, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 429.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 138.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 129.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 473.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 473.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 129.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 305.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 402.29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholinesterase Assay", "code_information": [ { "code": "82013", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.26, "discounted_cash": 12, "minimum": 11.178, "maximum": 37.26, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Influenza Virus Vac - G0008 - 77100008 - 77100008", "code_information": [ { "code": "G0008", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 247.03, "discounted_cash": 59, "minimum": 25, "maximum": 247.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Scr Auditory Potential W/Stimuli Auto Alys", "code_information": [ { "code": "92650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 273.6, "minimum": 25.68, "maximum": 273.6, "payers_information": [ { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 33.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.48 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.68 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.68 } ] } ] }, { "description": "Hc Agglutinins; Febrile", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.04, "discounted_cash": 6, "minimum": 6.1, "maximum": 203.04, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Albumin Ischemia Modified", "code_information": [ { "code": "82045", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 33, "minimum": 24.14, "maximum": 323.33, "payers_information": [ { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 24.14 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Qualit,Multi", "code_information": [ { "code": "86005", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 30.25, "discounted_cash": 7, "minimum": 7.97, "maximum": 30.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Quant,Each", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 5.22, "maximum": 116, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Pheno", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197, "discounted_cash": 14, "minimum": 14.46, "maximum": 197, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-1-Antitrypsin, Total", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 94.08, "discounted_cash": 13, "minimum": 13.44, "maximum": 94.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Multiple Qual", "code_information": [ { "code": "82128", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.87, "discounted_cash": 13, "minimum": 5.661, "maximum": 18.87, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.27, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Anesth Vag Delivery, Epidural", "code_information": [ { "code": "01967", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1151.33, "minimum": 77.11, "maximum": 1151.33, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.51 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.11 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.11 } ] } ] }, { "description": "Hc Angio Aortogram Thoracic", "code_information": [ { "code": "75600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6690.7, "discounted_cash": 4041, "minimum": 227.44, "maximum": 6690.7, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 227.44 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 243.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Unilat Select", "code_information": [ { "code": "75741", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 102.44, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 109.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angiography Iliac During Card Cath - 75710 - 32300016", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 130.84, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Biopsy Sing/Mult", "code_information": [ { "code": "46606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8307.5, "discounted_cash": 1531, "minimum": 41.65, "maximum": 8307.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1957.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2297.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 41.65 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2144.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2236.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2153.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Dilation", "code_information": [ { "code": "46604", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8307.5, "discounted_cash": 1531, "minimum": 56.6, "maximum": 8307.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1957.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2297.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1546.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 56.6 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2144.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2236.05, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2153.35, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1623.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 56.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 56.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens, Mlc, Each", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 155.1, "discounted_cash": 40, "minimum": 12.94, "maximum": 155.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 58.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 56.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Agar Diffusn,Ea", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.32, "discounted_cash": 4, "minimum": 1.33, "maximum": 109.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Enzyme Detection,Each", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.55, "discounted_cash": 4, "minimum": 1, "maximum": 125.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I High Definition Panel Qual", "code_information": [ { "code": "86832", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 884.17, "discounted_cash": 323, "minimum": 8.22, "maximum": 884.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 413.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 485.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 326.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 453.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 472.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 455.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 343.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 501.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 323.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 426.49, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antinomyces Antibody", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.35, "discounted_cash": 10, "minimum": 10.18, "maximum": 152.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1926.7, "discounted_cash": 2640, "minimum": 177.21, "maximum": 1926.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt >=100Sqcm Ea Ad 100Sqcm", "code_information": [ { "code": "15278", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1385, "minimum": 45.42, "maximum": 1385, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 45.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.6 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.42 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.42 } ] } ] }, { "description": "Hc 2D Tte W Or W/O Fol W/Con Complete - C8923 - 48300011", "code_information": [ { "code": "C8923", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3128.92, "discounted_cash": 1003, "minimum": 938.676, "maximum": 3128.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1282.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1504.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1013.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1404.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1464.83, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1410.65, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1063.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1555.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1555.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1003.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1321.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm Ea Ad 25Qsqcm", "code_information": [ { "code": "15272", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.62, "minimum": 14.15, "maximum": 660.62, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W/O Imaging Guidance", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8771.59, "discounted_cash": 1160, "minimum": 58.45, "maximum": 8771.59, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1632.1, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 62.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1230.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1529.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1483.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1741.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1172.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1625.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1694.78, "additional_payer_notes": "146.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Elbow To Finger Cast", "code_information": [ { "code": "29075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1116.45, "discounted_cash": 357, "minimum": 118.55, "maximum": 1116.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 126.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.55 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimj Panel 3 Beta-Hydroxydehyd Defncy", "code_information": [ { "code": "80406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.5, "discounted_cash": 78, "minimum": 62.61, "maximum": 1073.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 117.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 79.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 62.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 109.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 110.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 66.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 62.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 62.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 78.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 103.1, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Cast", "code_information": [ { "code": "29065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 658.95, "discounted_cash": 357, "minimum": 132.97, "maximum": 658.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 658.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 132.97 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 142.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 132.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 132.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Actin Smooth Muscle Antibody Each", "code_information": [ { "code": "86015", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60.25, "discounted_cash": 12, "minimum": 11.53, "maximum": 60.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Splint", "code_information": [ { "code": "29505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1062.3, "discounted_cash": 207, "minimum": 98.8, "maximum": 1062.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1062.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 98.8 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Activated Prot C (Apc) Resistnce Assay", "code_information": [ { "code": "85307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 301.3, "discounted_cash": 15, "minimum": 10.9, "maximum": 301.3, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.9 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Aquaporin-4 Antb Cba Each Ea", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12, "minimum": 3.615, "maximum": 12.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acylcarnitines Quant", "code_information": [ { "code": "82017", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 16, "minimum": 16.87, "maximum": 206.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Rbc Antibody Identification", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1889.69, "discounted_cash": 458, "minimum": 18.96, "maximum": 2362.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 688.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 463.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.79, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 645.02, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 486.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Pneumococcal Vac - G0009 - 77100009 - 77100009", "code_information": [ { "code": "G0009", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 334.63, "discounted_cash": 59, "minimum": 59.92, "maximum": 334.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Cath Prolngd Nfs Ther Chemotx Cutdown", "code_information": [ { "code": "36640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1355.75, "discounted_cash": 4041, "minimum": 121.22, "maximum": 1355.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 121.22 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 129.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1355.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Airway Inhalation Treatment", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1395.65, "discounted_cash": 280, "minimum": 16.78, "maximum": 1395.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 420.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 283.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 409.18, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 394.05, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 297.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Antibody", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170, "discounted_cash": 15, "minimum": 15.05, "maximum": 170, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein L3", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 398.81, "discounted_cash": 64, "minimum": 45.81, "maximum": 398.81, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biotinidase", "code_information": [ { "code": "82261", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.95, "discounted_cash": 16, "minimum": 6.885, "maximum": 22.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Abl1 Gene Analysis Kinase Domain Variants", "code_information": [ { "code": "81170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 962.28, "discounted_cash": 300, "minimum": 240, "maximum": 962.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 383.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 450, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 303, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 240 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 420, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 438 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 421.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 318, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 240 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 465, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 465, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 240 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 300, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 395.21, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, Single Quantitation", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.4, "discounted_cash": 22, "minimum": 21.07, "maximum": 269.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 35.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.27, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay C-D Transfer Measure", "code_information": [ { "code": "82373", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.22, "discounted_cash": 18, "minimum": 7.46, "maximum": 221.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.08, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate/ Reconstuct Atria, W Othr Proced Limitd", "code_information": [ { "code": "33257", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 74446.9, "minimum": 460.91, "maximum": 74446.9, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 493.17 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 460.91 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 460.91 } ] } ] }, { "description": "Hc Amniocentesis,Diagnostic", "code_information": [ { "code": "59000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1040.5, "discounted_cash": 1178, "minimum": 82.13, "maximum": 1040.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 82.13 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 82.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1040.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Carbamazepine Free", "code_information": [ { "code": "80157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 180.4, "discounted_cash": 13, "minimum": 8.79, "maximum": 180.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Reflex Testing", "code_information": [ { "code": "92568", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.08, "discounted_cash": 47, "minimum": 13.31, "maximum": 82.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amniocentesis,Ther Amniotic Fluid Reduct", "code_information": [ { "code": "59001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.96, "discounted_cash": 390, "minimum": 68.688, "maximum": 228.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 139.85 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 149.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 139.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 139.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 228.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Calprotectin Fecal", "code_information": [ { "code": "83993", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 456.25, "discounted_cash": 19, "minimum": 13.96, "maximum": 456.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.08, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.96 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 30.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Activity Therapy 45Min Or More, Mentl Disabl Php", "code_information": [ { "code": "G0176", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 370, "minimum": 35, "maximum": 370, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 84.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.45 } ] } ] }, { "description": "Hc Angio Adrenal Bilat Select", "code_information": [ { "code": "75733", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 148.76, "maximum": 7478.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 159.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 148.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Glucose, Body Fluid", "code_information": [ { "code": "82945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 207.29, "discounted_cash": 3, "minimum": 2.63, "maximum": 207.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 3.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus Ag Eia", "code_information": [ { "code": "87301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 11.59, "maximum": 138.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortobifemoral W Cath", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 104.04, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 111.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay L/S Ratio", "code_information": [ { "code": "83661", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.8, "discounted_cash": 21, "minimum": 17.94, "maximum": 59.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 34.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.99, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Adenovirus, Antibody", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69, "discounted_cash": 12, "minimum": 12.87, "maximum": 69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extermity Bilat", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14100, "discounted_cash": 4041, "minimum": 143.37, "maximum": 14100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 153.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Agent Nos Assay W/Optic", "code_information": [ { "code": "87899", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.9, "discounted_cash": 16, "minimum": 5.59, "maximum": 206.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 24.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.17, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Extremity Unilat", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7049.99, "discounted_cash": 4041, "minimum": 130.84, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acetaminophen - G0480 - 30100036", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.31, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Spec Ige Recombinant/Purified Compnt Ea", "code_information": [ { "code": "86008", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 89.65, "discounted_cash": 17, "minimum": 15.94, "maximum": 89.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angiotensin I Enzyme Test", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375, "discounted_cash": 14, "minimum": 14.6, "maximum": 375, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Acth", "code_information": [ { "code": "82024", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193.1, "discounted_cash": 38, "minimum": 38.62, "maximum": 193.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 39.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Allergen Specific Igg", "code_information": [ { "code": "86001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99.4, "discounted_cash": 7, "minimum": 4.54, "maximum": 99.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.3, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Anoscopy W Remove Foreign Body", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3763.8, "discounted_cash": 1190, "minimum": 154.87, "maximum": 3763.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1520.9, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1785.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1202.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1666.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1737.72, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1673.45, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 165.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1261.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1844.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1844.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1567.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acid Single Qual", "code_information": [ { "code": "82127", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.7, "discounted_cash": 14, "minimum": 14.15, "maximum": 188.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antb Severe Aqt Respir Synd Sars-Cov-2 Covid19", "code_information": [ { "code": "86769", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 122.4, "discounted_cash": 42, "minimum": 36.72, "maximum": 122.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.83, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 63.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 59.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 65.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ammonia", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 437.93, "discounted_cash": 14, "minimum": 14.57, "maximum": 437.93, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Abdom Paracentesis Dx/Ther W Imaging Guidance", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6401.78, "discounted_cash": 1160, "minimum": 89.72, "maximum": 6401.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1483.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1741.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1172.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1625.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1694.78, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1632.1, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1230.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1529.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 2-5 Quant", "code_information": [ { "code": "82136", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 19, "minimum": 18, "maximum": 206.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 30.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antegrade Urography Radiological Supvj & Interpj", "code_information": [ { "code": "74425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1064.7, "discounted_cash": 446, "minimum": 48.23, "maximum": 1064.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 51.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amphetamines - G0480 - 30100323", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190.35, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate Av Node Function", "code_information": [ { "code": "93650", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13778.7, "discounted_cash": 9982, "minimum": 1026.61, "maximum": 13778.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12755.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10082.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1098.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10581.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 13778.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1026.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9982.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13150.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amino Acids, 6+ Quant", "code_information": [ { "code": "82139", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.52, "discounted_cash": 16, "minimum": 16.87, "maximum": 130.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibiotic Sens,Mic,Each", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 375.44, "discounted_cash": 8, "minimum": 8.62, "maximum": 375.44, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androsterone", "code_information": [ { "code": "82160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.24, "discounted_cash": 25, "minimum": 25.51, "maximum": 272.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.33, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 39.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.66, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ablate L/R Atrial Fibril W Isolated Pulm Vein", "code_information": [ { "code": "93657", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20364, "minimum": 329.97, "maximum": 20364, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 329.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 353.07 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.97 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 329.97 } ] } ] }, { "description": "Hc Amp F/Th 1/2 Jt/Phalanx W/Neurect Local Flap", "code_information": [ { "code": "26952", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15420.2, "discounted_cash": 4187, "minimum": 445.91, "maximum": 15420.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5351.18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6281.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 445.91 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6114.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5887.92, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 477.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 445.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 445.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Apolipoprotein", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 179, "discounted_cash": 21, "minimum": 15.09, "maximum": 179, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.95, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acetylcholine Receptor Binding Antibody", "code_information": [ { "code": "86041", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115, "discounted_cash": 18, "minimum": 18.4, "maximum": 115, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Androstanediol Glucuronide", "code_information": [ { "code": "82154", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 313.92, "discounted_cash": 28, "minimum": 28.83, "maximum": 313.92, "payers_information": [ { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.84, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 29.41 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 44.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.83, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antidepressants Tricyclic & Cyclicals 6/More - G0480 - 30100422", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.74, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acne Surgery Of Skin Abscess", "code_information": [ { "code": "10040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.4, "discounted_cash": 256, "minimum": 55.62, "maximum": 185.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 68.89 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Nonselec", "code_information": [ { "code": "75746", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 114.47, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 114.47 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 114.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 114.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cadmium", "code_information": [ { "code": "82300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 136, "discounted_cash": 23, "minimum": 23.6, "maximum": 136, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 36.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acoustic Immitance Testing", "code_information": [ { "code": "92570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.75, "discounted_cash": 164, "minimum": 26.84, "maximum": 589.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 247.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 240.43, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 231.54, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 174.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pulmon Bilat Select", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 104.21, "maximum": 17368.6, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 111.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Antiepileptics Not Otherwise Specified 1-3 - G0480 - 30100444", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Ionized", "code_information": [ { "code": "82330", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 321.95, "discounted_cash": 13, "minimum": 13.68, "maximum": 321.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel", "code_information": [ { "code": "80400", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 310.73, "discounted_cash": 32, "minimum": 26.1, "maximum": 310.73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.93, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 26.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.58, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 50.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.97, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Retro Brachial Angio", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 130.84, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 140 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Dir Ea Antiserum", "code_information": [ { "code": "86880", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.78, "discounted_cash": 75, "minimum": 5.5, "maximum": 226.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 113.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 110.23, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Chromium", "code_information": [ { "code": "82495", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.4, "discounted_cash": 20, "minimum": 20.28, "maximum": 248.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 31.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.69 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Acth Stimulation Panel 21 Hydroxylase Deficiency", "code_information": [ { "code": "80402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1192.8, "discounted_cash": 86, "minimum": 69.57, "maximum": 1192.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.44, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 69.57 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 121.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 126.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 122.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 74.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 92.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 69.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 134.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 69.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.96, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.56, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angrph Cath F-Up Std Tcat Othr Than Thrombylsis", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 99.85, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 106.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indirect Ea Antibody Titer", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167.4, "discounted_cash": 218, "minimum": 4.84, "maximum": 167.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 167.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Adjacent Tissue Trns/Reargmt F/C/C/M/N/A/G/H/F 10Sqcm/&Lt", "code_information": [ { "code": "14040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3737.22, "discounted_cash": 2640, "minimum": 483.82, "maximum": 3737.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3374.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3600, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 3600, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 483.82 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3697.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3737.22, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 3712.85, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 517.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2799.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 483.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 3737.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 3737.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 483.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3478.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class I & Class Ii Antigens Qual", "code_information": [ { "code": "86828", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1050, "discounted_cash": 64, "minimum": 34.47, "maximum": 1050, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.02, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 34.47 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 89.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 93.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 99.49, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.56, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.19, "discounted_cash": 12, "minimum": 12.09, "maximum": 280.19, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatine", "code_information": [ { "code": "82540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128, "discounted_cash": 4, "minimum": 4.64, "maximum": 128, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.11, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Admin Hep B Vac - G0010 - 77100010 - 77100010", "code_information": [ { "code": "G0010", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 267.7, "discounted_cash": 59, "minimum": 59.92, "maximum": 267.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 89.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 60.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.48, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 84.25, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 63.52, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antineutrophil Cytoplasmic Antb Titer Ea Antb", "code_information": [ { "code": "86037", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75.56, "discounted_cash": 12, "minimum": 12.05, "maximum": 75.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antinuclear Antibodies Titer", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 289.54, "discounted_cash": 11, "minimum": 11.16, "maximum": 289.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aep Hearing Status Deter Broadband Stimuli I&R", "code_information": [ { "code": "92651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 810, "discounted_cash": 276, "minimum": 80.62, "maximum": 810, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.13, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 414.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 279.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 80.62 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 386.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 403.47, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 388.55, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 86.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 292.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 428.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 428.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Activ", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.25, "discounted_cash": 11, "minimum": 11.85, "maximum": 59.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Screen", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 109.9, "discounted_cash": 5, "minimum": 5.77, "maximum": 109.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogens", "code_information": [ { "code": "82671", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.5, "discounted_cash": 32, "minimum": 18.75, "maximum": 62.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 45.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 35.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 50.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detect Nos, Eia, Mult Step", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351.53, "discounted_cash": 11, "minimum": 9.64, "maximum": 351.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm Ea Ad 25Cm", "code_information": [ { "code": "15276", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1170, "minimum": 20.48, "maximum": 1170, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.91 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.48 } ] } ] }, { "description": "Hc Aortic Dys/Dilat Genom Seq Ana", "code_information": [ { "code": "81410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2750, "discounted_cash": 504, "minimum": 504, "maximum": 2750, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 644.03, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 756, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 509.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 705.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 735.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 708.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 534.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 781.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 504, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 663.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ag Detection Polyval If", "code_information": [ { "code": "87300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 138.93, "discounted_cash": 11, "minimum": 4.11, "maximum": 138.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.11 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.11 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.11 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm 1St 100Sqcm", "code_information": [ { "code": "15273", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1926.7, "discounted_cash": 2640, "minimum": 172, "maximum": 1926.7, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 172 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 172 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 184.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 172 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1926.7, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15271", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10062.5, "discounted_cash": 945, "minimum": 72.23, "maximum": 10062.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1208.71, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1418.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 955.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 72.23 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1324.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1381.03, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1329.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1002.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 72.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1466.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1466.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 72.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethosuximide", "code_information": [ { "code": "80168", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.24, "discounted_cash": 16, "minimum": 6.672, "maximum": 22.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein, Serum", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 125.78, "discounted_cash": 16, "minimum": 16.77, "maximum": 125.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 97.54 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.78, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 97.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 97.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint", "code_information": [ { "code": "29126", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 676.97, "discounted_cash": 170, "minimum": 92.39, "maximum": 676.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 676.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Appl Multlay Comprs Arm/Hand", "code_information": [ { "code": "29584", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 639.35, "discounted_cash": 207, "minimum": 12.66, "maximum": 639.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 311.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fentanyl - G0480 - 30100020", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 217.27, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Alpha-Fetoprotein; Amniotic", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 322.05, "discounted_cash": 17, "minimum": 13.8, "maximum": 322.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.39, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Leg Cast", "code_information": [ { "code": "29345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1398.77, "discounted_cash": 357, "minimum": 174.09, "maximum": 1398.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1398.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 174.09 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 186.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 174.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 174.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Application Of Finger Splint", "code_information": [ { "code": "29131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 261.85, "discounted_cash": 75, "minimum": 48.07, "maximum": 261.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 261.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 76.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 110.23, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 106.15, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 51.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ferritin", "code_information": [ { "code": "82728", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.49, "discounted_cash": 13, "minimum": 13.63, "maximum": 175.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Amputation Of Finger/Thumb", "code_information": [ { "code": "26951", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4735.67, "discounted_cash": 4187, "minimum": 374.88, "maximum": 4735.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4229.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 401.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4438.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 374.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4735.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Multlay Comprs Lwr Leg", "code_information": [ { "code": "29581", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 849.84, "discounted_cash": 207, "minimum": 77.81, "maximum": 849.84, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 849.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 77.81 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Lower Leg Splint", "code_information": [ { "code": "29515", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1062.3, "discounted_cash": 207, "minimum": 81.17, "maximum": 1062.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1062.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 81.17 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 86.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 81.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 81.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fetal Fibronectin", "code_information": [ { "code": "82731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 671.5, "discounted_cash": 64, "minimum": 44.95, "maximum": 671.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 96.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 90.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 99.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 84.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Adrenal Unilat Select", "code_information": [ { "code": "75731", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8505.98, "discounted_cash": 4041, "minimum": 136.04, "maximum": 8505.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 145.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 136.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aquatic Therapy/Exercises Ea 15 Min", "code_information": [ { "code": "97113", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 224.03, "discounted_cash": 41, "minimum": 19.98, "maximum": 224.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 64.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Rigid Leg Cast", "code_information": [ { "code": "29445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 982.9, "discounted_cash": 357, "minimum": 195.98, "maximum": 982.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 982.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 209.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 195.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Folic Acid, Rbc", "code_information": [ { "code": "82747", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 269.5, "discounted_cash": 17, "minimum": 13.19, "maximum": 269.5, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.19 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.19 } ] } ] }, { "description": "Hc Angio Aortogram Abd Serial", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17368.6, "discounted_cash": 4041, "minimum": 102.25, "maximum": 17368.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6061.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5900.06, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5681.84, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 109.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Freeze & Thaw Per Unit", "code_information": [ { "code": "86932", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 47, "minimum": 47.79, "maximum": 380.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood Thaw Per Unit", "code_information": [ { "code": "86931", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625.6, "discounted_cash": 218, "minimum": 187.68, "maximum": 625.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 278.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of For Hva", "code_information": [ { "code": "83150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 236.97, "discounted_cash": 22, "minimum": 13.08, "maximum": 236.97, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.64, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 34.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Aortogram Thor Serial", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 7121, "minimum": 98.32, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7193, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10397.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10013.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7549.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Interm Jt/Burs W/Us", "code_information": [ { "code": "20606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3756.76, "discounted_cash": 903, "minimum": 45.05, "maximum": 3756.76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1154.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1355.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 912.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1264.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1319.01, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1270.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 957.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1400.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1400.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.05 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 903.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1190.13, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Frozen Blood,Freezing", "code_information": [ { "code": "86930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 380.35, "discounted_cash": 218, "minimum": 84.6, "maximum": 380.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 278.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 327.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 305.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 318.35, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 306.58, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 231.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Ige", "code_information": [ { "code": "82785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.46, "discounted_cash": 16, "minimum": 4.938, "maximum": 16.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Ea Addnl Selectv Vessel", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4090.24, "minimum": 87.74, "maximum": 4090.24, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 93.88 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 } ] } ] }, { "description": "Hc Arthrogram Of Ankle", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2370.55, "discounted_cash": 446, "minimum": 79.92, "maximum": 2370.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 85.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arterial Line Insertion", "code_information": [ { "code": "36620", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1161.35, "minimum": 60.35, "maximum": 1161.35, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 64.57 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.35 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.35 } ] } ] }, { "description": "Hc Assay Of Gentamicin", "code_information": [ { "code": "80170", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 468.58, "discounted_cash": 16, "minimum": 16.38, "maximum": 468.58, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 25.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.58, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Intern Mammary", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5508.3, "discounted_cash": 4041, "minimum": 143.9, "maximum": 5508.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 153.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4283.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 5508.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Knee Joint", "code_information": [ { "code": "73580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2148.09, "discounted_cash": 446, "minimum": 76.45, "maximum": 2148.09, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 76.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 81.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.45 } ] } ] }, { "description": "Hc Arthrogram Of Elbow", "code_information": [ { "code": "73085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2182.43, "discounted_cash": 446, "minimum": 73.14, "maximum": 2182.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 73.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucagon", "code_information": [ { "code": "82943", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "discounted_cash": 14, "minimum": 6.3, "maximum": 21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Angio Pelvis", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 7121, "minimum": 124.31, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7193, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10397.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10013.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 133.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7549.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Shoulder", "code_information": [ { "code": "73040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1454.95, "discounted_cash": 446, "minimum": 53.81, "maximum": 1454.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 53.81 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 57.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 53.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 53.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Hip", "code_information": [ { "code": "73525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1454.95, "discounted_cash": 446, "minimum": 78.84, "maximum": 1454.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 78.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 84.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemosiderin, Qual", "code_information": [ { "code": "83070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 123, "discounted_cash": 4, "minimum": 4.75, "maximum": 123, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 } ] } ] }, { "description": "Hc Angio Visceral Selectv/Subselec", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37458.6, "discounted_cash": 7121, "minimum": 121.45, "maximum": 37458.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10682.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7193, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10397.8, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10013.22, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 129.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7549.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrogram Of Wrist", "code_information": [ { "code": "73115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1039.25, "discounted_cash": 446, "minimum": 44.26, "maximum": 1039.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 669.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 450.97, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 651.89, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 627.78, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 47.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 473.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Ashkenazi Jewish Assoc Dsrdrs Gen Seq Anal 9 Gen", "code_information": [ { "code": "81412", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2100, "discounted_cash": 2448, "minimum": 630, "maximum": 2100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2100 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2100, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Inorganic Phosphorus", "code_information": [ { "code": "84100", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 249.78, "discounted_cash": 4, "minimum": 4.74, "maximum": 249.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.83 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay 17-(17-Ks)Ketosteroids", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.65, "discounted_cash": 12, "minimum": 7.095, "maximum": 23.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Asp/Drain Large Joint/Bursa", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1585.23, "discounted_cash": 392, "minimum": 65.68, "maximum": 1585.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.58, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 70.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin", "code_information": [ { "code": "83527", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.95, "discounted_cash": 12, "minimum": 3.885, "maximum": 12.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Detection Nos If", "code_information": [ { "code": "87299", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.5, "discounted_cash": 16, "minimum": 11.59, "maximum": 80.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.07, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 24.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase", "code_information": [ { "code": "84075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.43, "discounted_cash": 5, "minimum": 4.74, "maximum": 19.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.74 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aspergillus Ag Eia", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.95, "discounted_cash": 11, "minimum": 6.93, "maximum": 29.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ketogenic Steroids", "code_information": [ { "code": "83582", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 192.8, "discounted_cash": 15, "minimum": 14.46, "maximum": 192.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.38, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii High Definition Panel Qual", "code_information": [ { "code": "86833", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846, "discounted_cash": 325, "minimum": 8.22, "maximum": 846, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 504.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 429.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 416.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 488.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 329.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 456.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 475.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 458.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 345.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 325.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Lipoprotein Pla2", "code_information": [ { "code": "83698", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 323.33, "discounted_cash": 46, "minimum": 29.56, "maximum": 323.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.18, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.77, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 64.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 67.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 65.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 49.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 71.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 46.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.01, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkaline Phosphatase ,Isoenzymes", "code_information": [ { "code": "84080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296.25, "discounted_cash": 14, "minimum": 14.78, "maximum": 296.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lap Enzyme", "code_information": [ { "code": "83670", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66, "discounted_cash": 9, "minimum": 9.35, "maximum": 66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.54, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Hla Class Ii Phenotype Panel Qual", "code_information": [ { "code": "86831", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 605, "discounted_cash": 81, "minimum": 8.22, "maximum": 605, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 104.63, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 122.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 82.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 114.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 119.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 115.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 86.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 126.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.22 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 81.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 107.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Androstenedione", "code_information": [ { "code": "82157", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 426, "discounted_cash": 29, "minimum": 29.28, "maximum": 426, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 45.38, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.86 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Dioxide", "code_information": [ { "code": "82374", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.5, "discounted_cash": 4, "minimum": 1.56, "maximum": 121.5, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.43, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.24, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 1.56 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.56, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipase", "code_information": [ { "code": "83690", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.37, "discounted_cash": 6, "minimum": 6.89, "maximum": 341.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antibody Treponema Pallidum", "code_information": [ { "code": "86780", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.16, "discounted_cash": 13, "minimum": 9.12, "maximum": 119.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.44, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Angiotensin Ii", "code_information": [ { "code": "82163", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 251.37, "discounted_cash": 20, "minimum": 20.52, "maximum": 251.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.93 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 31.81, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Phencyclidine", "code_information": [ { "code": "83992", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.6, "discounted_cash": 20, "minimum": 20, "maximum": 142.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lipoprotein(A)", "code_information": [ { "code": "83695", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71.6, "discounted_cash": 14, "minimum": 9.21, "maximum": 71.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.2, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antihuman Globulin Indir Qual Ea Reagent Cell", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 159.5, "discounted_cash": 218, "minimum": 5.84, "maximum": 159.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 159.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Chloride", "code_information": [ { "code": "82435", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 151.88, "discounted_cash": 4, "minimum": 3.45, "maximum": 151.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.13, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.06, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 5-Hiaa", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.55, "discounted_cash": 12, "minimum": 5.265, "maximum": 17.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.55, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lithium", "code_information": [ { "code": "80178", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.63, "discounted_cash": 6, "minimum": 6.61, "maximum": 82.63, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antistreptolysin O Titer", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 140, "discounted_cash": 7, "minimum": 7.3, "maximum": 140, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Osmolality", "code_information": [ { "code": "83930", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 260.28, "discounted_cash": 6, "minimum": 6.61, "maximum": 260.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Adp & Amp", "code_information": [ { "code": "82030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.88, "discounted_cash": 25, "minimum": 25.8, "maximum": 280.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 39.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.31 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Manganese", "code_information": [ { "code": "83785", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 146.5, "discounted_cash": 26, "minimum": 25.08, "maximum": 146.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 41.31, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Antithrombin Iii Test,Antigen", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 108.1, "discounted_cash": 10, "minimum": 10.81, "maximum": 108.1, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carotene", "code_information": [ { "code": "82380", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189, "discounted_cash": 9, "minimum": 9.22, "maximum": 189, "payers_information": [ { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 14.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.15, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.41 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldolase", "code_information": [ { "code": "82085", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.55, "discounted_cash": 9, "minimum": 9.71, "maximum": 48.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Metanephrines", "code_information": [ { "code": "83835", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84.7, "discounted_cash": 16, "minimum": 16.94, "maximum": 84.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.41, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.96, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Head/Hnd/Ft/Gnt Ttl 100Sqcm 1St 25 Sqcm", "code_information": [ { "code": "15275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10062.5, "discounted_cash": 945, "minimum": 83.02, "maximum": 10062.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1208.71, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1418.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 955.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1324.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1381.03, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 1329.95, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 88.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1002.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 1466.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 1466.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 83.02 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 945.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1246.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Chloramphenicol", "code_information": [ { "code": "82415", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.4, "discounted_cash": 12, "minimum": 12.67, "maximum": 172.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aldosterone", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.16, "discounted_cash": 40, "minimum": 40.75, "maximum": 211.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.13, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 57.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methadone - G0480 - 30100205", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.98, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc App Skn Sub Trnk/Arm/Leg >=100Sqcm Ea Add 100Sqcm", "code_information": [ { "code": "15274", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2711, "minimum": 36.49, "maximum": 2711, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.04 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.49 } ] } ] }, { "description": "Hc Assay Of Copper", "code_information": [ { "code": "82525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.05, "discounted_cash": 12, "minimum": 12.41, "maximum": 62.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.86, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amitriptyline - G0480 - 30100408", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.24, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nickel", "code_information": [ { "code": "83885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.72, "discounted_cash": 24, "minimum": 24.51, "maximum": 266.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 37.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Finger Splint Static", "code_information": [ { "code": "29130", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.21, "discounted_cash": 170, "minimum": 32.04, "maximum": 846.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 846.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 32.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Creatinine", "code_information": [ { "code": "82565", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.88, "discounted_cash": 5, "minimum": 4.95, "maximum": 186.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amylase", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320.95, "discounted_cash": 6, "minimum": 6.48, "maximum": 320.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nos Vitamin", "code_information": [ { "code": "84591", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 157.9, "discounted_cash": 17, "minimum": 10.1, "maximum": 157.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.47, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Forearm Splint Static", "code_information": [ { "code": "29125", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 846.21, "discounted_cash": 170, "minimum": 75.84, "maximum": 846.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 846.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 81.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 75.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryoglobulin", "code_information": [ { "code": "82595", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 137.09, "discounted_cash": 6, "minimum": 6.1, "maximum": 137.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ascorbic Acid", "code_information": [ { "code": "82180", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.37, "discounted_cash": 9, "minimum": 9.89, "maximum": 185.37, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.89, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.03, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nucleotidase 5'", "code_information": [ { "code": "83915", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.5, "discounted_cash": 11, "minimum": 11.15, "maximum": 111.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.15, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Long Arm Splint", "code_information": [ { "code": "29105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1062.3, "discounted_cash": 207, "minimum": 95.06, "maximum": 1062.3, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 220.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 95.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 322.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 95.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 273.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 265.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1062.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 210.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 95.06 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 291.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 303.65, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 292.42, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.71 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 207.98, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyclosporine", "code_information": [ { "code": "80158", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 466.25, "discounted_cash": 18, "minimum": 18.05, "maximum": 466.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.08, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply Short Leg Cast", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1116.45, "discounted_cash": 357, "minimum": 122.3, "maximum": 1116.45, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1116.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 522.64, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 503.31, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 379.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Digoxin", "code_information": [ { "code": "80162", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 450.9, "discounted_cash": 13, "minimum": 13.28, "maximum": 450.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.49, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Fatty Acids", "code_information": [ { "code": "82725", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.12, "discounted_cash": 18, "minimum": 5.436, "maximum": 18.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.64 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Osteocalcin", "code_information": [ { "code": "83937", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.25, "discounted_cash": 29, "minimum": 21.675, "maximum": 72.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 46.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 46.27, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Apply/Remove Cranial Fix Dev", "code_information": [ { "code": "20660", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3566.25, "discounted_cash": 2058, "minimum": 181.57, "maximum": 3566.25, "payers_information": [ { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 3189.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 3189.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2711.12, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2629.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3087.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2078.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 181.57 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2881.21, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3004.69, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 2893.56, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 194.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 2058.01, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2181.49, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrone", "code_information": [ { "code": "82679", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.6, "discounted_cash": 24, "minimum": 24.95, "maximum": 285.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.88, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 38.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Hdl Cholest", "code_information": [ { "code": "83718", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 215, "discounted_cash": 8, "minimum": 7.75, "maximum": 215, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.68, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.69, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Phenobarbital", "code_information": [ { "code": "80184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 341.55, "discounted_cash": 15, "minimum": 9.64, "maximum": 341.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Abo", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 676.97, "discounted_cash": 170, "minimum": 2.73, "maximum": 846.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 255.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 171.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 248.61, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 239.41, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 180.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Pku", "code_information": [ { "code": "84030", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.91, "discounted_cash": 5, "minimum": 5.5, "maximum": 21.91, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone 17-D", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 303, "discounted_cash": 27, "minimum": 27.17, "maximum": 303, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.76, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arc Blood Typing, Rh (D)", "code_information": [ { "code": "86901", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 198, "discounted_cash": 47, "minimum": 2.82, "maximum": 297.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.69, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.77, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.19, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of C-Peptide", "code_information": [ { "code": "84681", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 104.05, "discounted_cash": 20, "minimum": 20.46, "maximum": 104.05, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Progesterone Receptor", "code_information": [ { "code": "84234", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286, "discounted_cash": 64, "minimum": 60.97, "maximum": 286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 82.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 65.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 60.97 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 90.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 91.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 68.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 100.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 100.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.47, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Arthro Hip Wo Anesth", "code_information": [ { "code": "27093", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1409.87, "minimum": 288.9, "maximum": 1409.87, "payers_information": [ { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 288.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 309.12 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 288.9 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 288.9 } ] } ] }, { "description": "Hc Assay Of Galactose", "code_information": [ { "code": "82760", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.4, "discounted_cash": 11, "minimum": 11.2, "maximum": 152.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcitonin", "code_information": [ { "code": "82308", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133.95, "discounted_cash": 26, "minimum": 26.79, "maximum": 133.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 41.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prolactin", "code_information": [ { "code": "84146", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 145.35, "discounted_cash": 19, "minimum": 19.38, "maximum": 145.35, "payers_information": [ { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 30.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Arthrocentesis Aspir&/Inj Major Jt/Bursa W/Us", "code_information": [ { "code": "20611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1585.23, "discounted_cash": 392, "minimum": 52.87, "maximum": 1585.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 502.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 589.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 396.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 52.87 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.58, "additional_payer_notes": "146.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 552.36, "additional_payer_notes": "140.60% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 56.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 416.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 52.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 52.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gastrin", "code_information": [ { "code": "82941", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 142.9, "discounted_cash": 17, "minimum": 17.63, "maximum": 142.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carbamazepine Total", "code_information": [ { "code": "80156", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 410, "discounted_cash": 14, "minimum": 14.47, "maximum": 410, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostaglandin", "code_information": [ { "code": "84150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 271.68, "discounted_cash": 41, "minimum": 31.18, "maximum": 271.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.37, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 44.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 64.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 64.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 55.03, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Aspa Gene", "code_information": [ { "code": "81200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 556, "discounted_cash": 47, "minimum": 47.25, "maximum": 556, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.38, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 68.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 73.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 73.24, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ggt", "code_information": [ { "code": "82977", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 7, "minimum": 7.2, "maximum": 90, "payers_information": [ { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.48, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.34 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7.2, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Carnitine", "code_information": [ { "code": "82379", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 16, "minimum": 16.87, "maximum": 206.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - 84153 - 30100312", "code_information": [ { "code": "84153", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.75, "discounted_cash": 18, "minimum": 18.39, "maximum": 368.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Alkal Phosphatase,Heat Stabl W/O Total", "code_information": [ { "code": "84078", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.28, "discounted_cash": 8, "minimum": 6.98, "maximum": 119.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.61 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Hemoglobin Heat", "code_information": [ { "code": "83065", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.56, "discounted_cash": 9, "minimum": 8.26, "maximum": 112.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ceruloplasmin", "code_information": [ { "code": "82390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 107.4, "discounted_cash": 10, "minimum": 10.74, "maximum": 107.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate", "code_information": [ { "code": "84210", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.77, "discounted_cash": 14, "minimum": 4.431, "maximum": 14.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.77, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Biovlbl Testosterone Direct Measurement", "code_information": [ { "code": "84410", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316.6, "discounted_cash": 51, "minimum": 45.58, "maximum": 316.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 65.53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 45.58 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 72.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 54.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.58 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 79.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.58 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Homocystine", "code_information": [ { "code": "83090", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 535, "discounted_cash": 17, "minimum": 11.99, "maximum": 535, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.9, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.99 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Citrate", "code_information": [ { "code": "82507", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 311.24, "discounted_cash": 27, "minimum": 27.8, "maximum": 311.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.7, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 28.36 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 39.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 43.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 28.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 36.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Quinidine", "code_information": [ { "code": "80194", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.5, "discounted_cash": 14, "minimum": 14.6, "maximum": 220.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.9, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Blood Carbon Monoxide", "code_information": [ { "code": "82375", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246, "discounted_cash": 12, "minimum": 12.32, "maximum": 246, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Imipramine - G0480 - 30100017", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 210.78, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ck (Cpk)", "code_information": [ { "code": "82550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259.11, "discounted_cash": 6, "minimum": 6.51, "maximum": 259.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.58, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Selenium", "code_information": [ { "code": "84255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.8, "discounted_cash": 25, "minimum": 11.04, "maximum": 36.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.79, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay For Collagen Cross Links", "code_information": [ { "code": "82523", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 281.75, "discounted_cash": 18, "minimum": 18.68, "maximum": 281.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.02, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Iron", "code_information": [ { "code": "83540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 220.16, "discounted_cash": 6, "minimum": 6.47, "maximum": 220.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.56 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.56 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.56 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosteroids", "code_information": [ { "code": "83491", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 23.84, "discounted_cash": 17, "minimum": 7.152, "maximum": 23.84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.87, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.08, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.84 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.58, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serotonin", "code_information": [ { "code": "84260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 418.27, "discounted_cash": 30, "minimum": 30.98, "maximum": 418.27, "payers_information": [ { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 48.02, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.81, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 46.47, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 31.6 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 32.84, "additional_payer_notes": "106.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Galactose Transferase", "code_information": [ { "code": "82775", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.67, "discounted_cash": 21, "minimum": 8.601, "maximum": 28.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.49 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.76, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lidocaine", "code_information": [ { "code": "80176", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.99, "discounted_cash": 14, "minimum": 5.997, "maximum": 19.99, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Dibucaine Number", "code_information": [ { "code": "82638", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 166.6, "discounted_cash": 12, "minimum": 12.25, "maximum": 166.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.5 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Theophylline", "code_information": [ { "code": "80198", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 282, "discounted_cash": 14, "minimum": 14.14, "maximum": 282, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.42 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Growth Hormone (Hgh)", "code_information": [ { "code": "83003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 378, "discounted_cash": 16, "minimum": 16.67, "maximum": 378, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.34 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 25.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Methemalbumin", "code_information": [ { "code": "83857", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 160.82, "discounted_cash": 10, "minimum": 10.74, "maximum": 160.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.11, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.85, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.15, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Doxepin - G0480 - 30100409", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.81, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thiocyanate", "code_information": [ { "code": "84430", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 71, "discounted_cash": 11, "minimum": 11.63, "maximum": 71, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of 17-Hydroxypregneno", "code_information": [ { "code": "84143", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 248.4, "discounted_cash": 22, "minimum": 22.81, "maximum": 248.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 35.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Endocrine Hormone", "code_information": [ { "code": "84235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 427.38, "discounted_cash": 71, "minimum": 65.39, "maximum": 427.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 91.02, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 106.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 65.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 99.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 104 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 100.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 69.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 110.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 110.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 71.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 93.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroid Stim Immunoglobulins (Tsi)", "code_information": [ { "code": "84445", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 50, "minimum": 50.86, "maximum": 200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.99, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 76.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 51.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 51.87 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 71.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 71.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 55.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 53.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 51.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 78.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 51.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 50.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Aluminum", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.67, "discounted_cash": 25, "minimum": 10.401, "maximum": 34.67, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 34.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 34.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.57, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.67, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 34.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Opiates - G0480 - 30100328", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238.32, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Free Thyroxine", "code_information": [ { "code": "84439", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 328.31, "discounted_cash": 9, "minimum": 9.02, "maximum": 328.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 13.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Total Thyroxine", "code_information": [ { "code": "84436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 266.25, "discounted_cash": 6, "minimum": 5.94, "maximum": 266.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.94 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.94 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.94 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Amikacin", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 272.5, "discounted_cash": 15, "minimum": 15.08, "maximum": 272.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Procalcitonin", "code_information": [ { "code": "84145", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 587.5, "discounted_cash": 27, "minimum": 17.77, "maximum": 587.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.83, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.77 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 39.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 38.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.01 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.85, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 42.19, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Gammaglobulin Iga, Igd, Igg, Igm, Each", "code_information": [ { "code": "82784", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 246.78, "discounted_cash": 9, "minimum": 6.98, "maximum": 246.78, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 14.42, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.88, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transferrin", "code_information": [ { "code": "84466", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.9, "discounted_cash": 12, "minimum": 9.57, "maximum": 31.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.81, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Proinsulin", "code_information": [ { "code": "84206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 340, "discounted_cash": 26, "minimum": 22.25, "maximum": 340, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.04, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.96, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 37.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.97 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 37.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 28.29, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 41.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 41.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glucosidase", "code_information": [ { "code": "82963", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 21, "minimum": 21.48, "maximum": 263.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Troponin Qual", "code_information": [ { "code": "84512", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 115.28, "discounted_cash": 10, "minimum": 9.26, "maximum": 115.28, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.19, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Arsenic", "code_information": [ { "code": "82175", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 229, "discounted_cash": 18, "minimum": 18.97, "maximum": 229, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.56, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.11, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 29.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Prostate Specific Antigen Total - G0103 - 30100312", "code_information": [ { "code": "G0103", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 368.75, "discounted_cash": 19, "minimum": 19.31, "maximum": 368.75, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.97, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 29.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.44, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haloperidol", "code_information": [ { "code": "80173", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.82, "discounted_cash": 15, "minimum": 5.946, "maximum": 19.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Troponin, Quant", "code_information": [ { "code": "84484", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 482.64, "discounted_cash": 12, "minimum": 9.72, "maximum": 482.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of B Hexosaminidase", "code_information": [ { "code": "83080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 206.55, "discounted_cash": 16, "minimum": 16.87, "maximum": 206.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.15, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pyruvate Kinase", "code_information": [ { "code": "84220", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.32, "discounted_cash": 9, "minimum": 8.496, "maximum": 28.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Haptoglobin, Quant", "code_information": [ { "code": "83010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 110.08, "discounted_cash": 12, "minimum": 12.58, "maximum": 110.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.08, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.87, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.49 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood", "code_information": [ { "code": "84550", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 209.97, "discounted_cash": 4, "minimum": 4.52, "maximum": 209.97, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Barbiturates - G0480 - 30100326", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 33.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Sodium", "code_information": [ { "code": "84295", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.38, "discounted_cash": 4, "minimum": 4.03, "maximum": 154.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.03 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.34, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Benzodiazepines - G0480 - 30100410", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.53, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatomedin", "code_information": [ { "code": "84305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228.5, "discounted_cash": 21, "minimum": 21.1, "maximum": 228.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.01, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Insulin,Total", "code_information": [ { "code": "83525", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.3, "discounted_cash": 11, "minimum": 9.18, "maximum": 114.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.61, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Alkaloids - G0480 - 30100213", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 285.95, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Blood Lipoprotein,Ldl Cholest", "code_information": [ { "code": "83721", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170.95, "discounted_cash": 10, "minimum": 9.43, "maximum": 170.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.43 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Somatostatin", "code_information": [ { "code": "84307", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 223.92, "discounted_cash": 18, "minimum": 18.28, "maximum": 223.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.69 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.08, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Phosphorus", "code_information": [ { "code": "84105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 168.48, "discounted_cash": 5, "minimum": 5.3, "maximum": 168.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.67, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium In Urine", "code_information": [ { "code": "82340", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152.72, "discounted_cash": 6, "minimum": 6.03, "maximum": 152.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.71, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.05, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.03, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Tacrolimus", "code_information": [ { "code": "80197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.11, "discounted_cash": 13, "minimum": 13.73, "maximum": 96.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.54, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.99 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Myoglobin", "code_information": [ { "code": "83874", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 129.2, "discounted_cash": 12, "minimum": 12.92, "maximum": 129.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.17 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sodium", "code_information": [ { "code": "84300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189.89, "discounted_cash": 5, "minimum": 4.96, "maximum": 189.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.59, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.96 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Calcium, Total", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 186.88, "discounted_cash": 5, "minimum": 4.7, "maximum": 186.88, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.21, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroglobulin", "code_information": [ { "code": "84432", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 238, "discounted_cash": 16, "minimum": 16.06, "maximum": 238, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.39 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.16, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Neonatal Thyroxine", "code_information": [ { "code": "84437", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 114.53, "discounted_cash": 6, "minimum": 6.47, "maximum": 114.53, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.06, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.86, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Sulfate", "code_information": [ { "code": "84392", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.9, "discounted_cash": 5, "minimum": 5.04, "maximum": 96.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.02, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.24, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.02 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.51, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cocaine - G0480 - 30100327", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 185.58, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 } ] } ] }, { "description": "Hc Assay Of Topiramate", "code_information": [ { "code": "80201", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.6, "discounted_cash": 11, "minimum": 11.92, "maximum": 59.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.76 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.15 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.7, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Nortiptyline - G0480 - 30100013", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 184.4, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Vma", "code_information": [ { "code": "84585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 214.06, "discounted_cash": 15, "minimum": 15.5, "maximum": 214.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.81, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.25, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 24.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 24.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.81 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.42, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Corticosterone", "code_information": [ { "code": "82528", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 245.12, "discounted_cash": 22, "minimum": 22.52, "maximum": 245.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.78, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.53, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.87, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 34.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 34.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Transcortin", "code_information": [ { "code": "84449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 205.74, "discounted_cash": 18, "minimum": 18, "maximum": 205.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 27.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Oxalate", "code_information": [ { "code": "83945", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.52, "discounted_cash": 14, "minimum": 5.256, "maximum": 17.52, "payers_information": [ { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 17.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.52, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vancomycin", "code_information": [ { "code": "80202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 489.62, "discounted_cash": 13, "minimum": 13.54, "maximum": 489.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cpk In Blood", "code_information": [ { "code": "82552", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 293.41, "discounted_cash": 13, "minimum": 13.39, "maximum": 293.41, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.09, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.52, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.64, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Uric Acid, Blood, Other Source", "code_information": [ { "code": "84560", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 163.08, "discounted_cash": 5, "minimum": 4.84, "maximum": 163.08, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.49, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.69, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Parathormone", "code_information": [ { "code": "83970", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 625, "discounted_cash": 41, "minimum": 39.98, "maximum": 625, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 57.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 43.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 63.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.38, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vip", "code_information": [ { "code": "84586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.6, "discounted_cash": 35, "minimum": 15.18, "maximum": 50.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 45.15, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 37.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 50.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 50.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cryofibrinogen", "code_information": [ { "code": "82585", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 128.48, "discounted_cash": 14, "minimum": 10.72, "maximum": 128.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Chloride", "code_information": [ { "code": "82436", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 162.12, "discounted_cash": 5, "minimum": 5.04, "maximum": 162.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Porphyrins Urine Quan&Fxj", "code_information": [ { "code": "84120", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 274.52, "discounted_cash": 14, "minimum": 14.71, "maximum": 274.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.01 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.38, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-1", "code_information": [ { "code": "84425", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 106.15, "discounted_cash": 21, "minimum": 21.23, "maximum": 106.15, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.13, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.23, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.97, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Cyanide", "code_information": [ { "code": "82600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.6, "discounted_cash": 19, "minimum": 19.4, "maximum": 77.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.79, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.56, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Creatinine", "code_information": [ { "code": "82570", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 203.43, "discounted_cash": 5, "minimum": 5.18, "maximum": 203.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.77, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.23, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.28 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.28 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnanetriol", "code_information": [ { "code": "84138", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 172.5, "discounted_cash": 21, "minimum": 19.32, "maximum": 172.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.9, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.58, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.6 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.73, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin E", "code_information": [ { "code": "84446", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 177.25, "discounted_cash": 14, "minimum": 13.77, "maximum": 177.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.12, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.94 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 21.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Erythropoietin", "code_information": [ { "code": "82668", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 187.9, "discounted_cash": 18, "minimum": 18.79, "maximum": 187.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.19, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 19.18 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.18 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 29.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.18 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urine Osmolality", "code_information": [ { "code": "83935", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.5, "discounted_cash": 6, "minimum": 6.82, "maximum": 242.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.71, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.91 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Pregnenolone", "code_information": [ { "code": "84140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 253.17, "discounted_cash": 20, "minimum": 20.67, "maximum": 253.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.18 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 29.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.57 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.91, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.67, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Other Fluid Chlorides", "code_information": [ { "code": "82438", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 165.24, "discounted_cash": 5, "minimum": 4.98, "maximum": 165.24, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.59, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estriol", "code_information": [ { "code": "82677", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 32.91, "discounted_cash": 24, "minimum": 9.873, "maximum": 32.91, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.9, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.42, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 32.91 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 32.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Valproic Acid, Total", "code_information": [ { "code": "80164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 412, "discounted_cash": 13, "minimum": 13.54, "maximum": 412, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.31, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.68, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.77 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.79 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 20.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.82 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Primidone", "code_information": [ { "code": "80188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 193, "discounted_cash": 16, "minimum": 16.59, "maximum": 193, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.2, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.89, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.33 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 25.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.93 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphatase Acid, Total", "code_information": [ { "code": "84060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.95, "discounted_cash": 7, "minimum": 4.185, "maximum": 13.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.76, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.46, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.15 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.74 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.06, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Estrogen", "code_information": [ { "code": "82672", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 376, "discounted_cash": 21, "minimum": 21.7, "maximum": 376, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 22.12 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.51 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 33.64, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.59, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin A", "code_information": [ { "code": "84590", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116.1, "discounted_cash": 11, "minimum": 11.61, "maximum": 116.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.84, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.42, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.54 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.72 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.29, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Quinine", "code_information": [ { "code": "84228", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 158.4, "discounted_cash": 11, "minimum": 11.63, "maximum": 158.4, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.63, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Phosphohexose Enzymes", "code_information": [ { "code": "84087", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154.55, "discounted_cash": 10, "minimum": 10.53, "maximum": 154.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.71, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.53 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.53 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 16.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.53 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethanol - G0480 - 30100052", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 589.31, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Rbc Protoporphyrin", "code_information": [ { "code": "84202", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 19.52, "discounted_cash": 14, "minimum": 5.856, "maximum": 19.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.34, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.49, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.63 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.9, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Rbc Galactokinase", "code_information": [ { "code": "82759", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 21, "minimum": 21.48, "maximum": 263.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.22, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.2 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.41 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 33.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.3, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Rbc Glutathione", "code_information": [ { "code": "82979", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 112.56, "discounted_cash": 9, "minimum": 8.61, "maximum": 112.56, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.53, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 14.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.44, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethchlorvynol - G0480 - 30100071", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 211.68, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Total Hydroxyproline", "code_information": [ { "code": "83505", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 264.72, "discounted_cash": 24, "minimum": 24.3, "maximum": 264.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 31.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.45, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.54, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.48 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 34.17 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.53 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 37.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.01, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Serum Albumin", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 164.8, "discounted_cash": 4, "minimum": 4.61, "maximum": 164.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.43, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.96 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Synovial Fluid Mucin", "code_information": [ { "code": "83872", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.72, "discounted_cash": 5, "minimum": 5.86, "maximum": 111.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.49, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.79, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.92, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 9.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Ethylene Glycol", "code_information": [ { "code": "82693", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 230, "discounted_cash": 14, "minimum": 14.9, "maximum": 230, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.04, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.35, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.26 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Bld/Serum Cholesterol", "code_information": [ { "code": "82465", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121.35, "discounted_cash": 4, "minimum": 4.35, "maximum": 121.35, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.35 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.61, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.73, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sex Hormone Binding Globulin", "code_information": [ { "code": "84270", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 259, "discounted_cash": 21, "minimum": 21.48, "maximum": 259, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.6, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 31.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 30.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 33.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.48 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 21.73, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Urine Urea-N", "code_information": [ { "code": "84540", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 167, "discounted_cash": 5, "minimum": 3.8, "maximum": 167, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.34, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.89, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.56, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Free Hydroxyproline", "code_information": [ { "code": "83500", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.92, "discounted_cash": 22, "minimum": 10.776, "maximum": 35.92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.98, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 31.85 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 24.01, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 35.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.1 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sialic Acid", "code_information": [ { "code": "84275", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.29, "discounted_cash": 13, "minimum": 5.487, "maximum": 18.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.29 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 18.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 1,25-Dihydroxy W Fractions", "code_information": [ { "code": "82652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 228, "discounted_cash": 38, "minimum": 38.07, "maximum": 228, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.2, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 57.75, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 38.07 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 53.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 56.21 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 54.13 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.73 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.81, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.07 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 59.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.07 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fluoride", "code_information": [ { "code": "82735", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 70, "discounted_cash": 18, "minimum": 18.54, "maximum": 70, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.69, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.81, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 18.91 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 27.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 26.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.91 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 28.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.91 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.42, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bacteria Culture Screen", "code_information": [ { "code": "87081", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 280.89, "discounted_cash": 6, "minimum": 6.52, "maximum": 280.89, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.47, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.95, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.98 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.03, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.52 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Sweat Sodium", "code_information": [ { "code": "84302", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.6, "discounted_cash": 4, "minimum": 3.46, "maximum": 48.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.29, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 3.46 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.1 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.83 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.7 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.46 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 7.53, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.46 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Vit D, 25-Hydroxy W Fractions", "code_information": [ { "code": "82306", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 296, "discounted_cash": 29, "minimum": 23.78, "maximum": 296, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.4, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 23.78 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.22 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.62 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.44 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.78 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 45.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.78 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.99, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Flurazepam - G0480 - 30100014", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 242.46, "discounted_cash": 114, "minimum": 2.922, "maximum": 978.69, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 171.65, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 160.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 68.43 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 121.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Keenan", "plan_name": "Keenan", "methodology": "percent of total billed charges", "standard_charge_percentage": 30, "median_amount": 63.95, "10th_percentile": 63.95, "90th_percentile": 63.95, "count": "1 through 10" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bactericidal Level Serum", "code_information": [ { "code": "87197", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 182.61, "discounted_cash": 15, "minimum": 15.02, "maximum": 182.61, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.53, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.93 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.12 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.4 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.28, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.33 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.02, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Testosterone", "code_information": [ { "code": "84402", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 258.1, "discounted_cash": 25, "minimum": 25.47, "maximum": 258.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.55, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.21, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.19 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.81 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 39.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Non-Endocrine Receptor", "code_information": [ { "code": "84238", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 503.75, "discounted_cash": 36, "minimum": 36.57, "maximum": 503.75, "payers_information": [ { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.18, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 54.86, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 37.29 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 51.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.39 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 51.42 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.9 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.76, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 56.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 36.57, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Fructose Semen", "code_information": [ { "code": "82757", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 263.16, "discounted_cash": 17, "minimum": 17.34, "maximum": 263.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.16, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.01, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.51, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.28, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.32 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.84, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bacterium, Antibody", "code_information": [ { "code": "86609", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 175.3, "discounted_cash": 12, "minimum": 12.88, "maximum": 175.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.46, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.32, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.8 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.06 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 19.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.97, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Thyroxine Bndng Globulin", "code_information": [ { "code": "84442", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 190, "discounted_cash": 14, "minimum": 14.78, "maximum": 190, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.17, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.93, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.78 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.08 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.47, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay, Three Catecholamines", "code_information": [ { "code": "82384", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90.3, "discounted_cash": 25, "minimum": 25.25, "maximum": 90.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 32.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 37.88, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 25.76 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 36.87 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.5 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 39.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of G6Pd Enzyme", "code_information": [ { "code": "82955", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 48.5, "discounted_cash": 9, "minimum": 9.7, "maximum": 48.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.55, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.16 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.58 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Balloon Dilat Ureteral Stricture W/Img Gdn Rs&I", "code_information": [ { "code": "50706", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4098, "minimum": 699.92, "maximum": 4098, "payers_information": [ { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3600, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "case rate", "standard_charge_dollar": 3600, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 699.92 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 748.91 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 699.92 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 699.92 } ] } ] }, { "description": "Hc Assay Of Tobramycin", "code_information": [ { "code": "80200", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 451.94, "discounted_cash": 16, "minimum": 16.13, "maximum": 451.94, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.25, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.61, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.2, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.68 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.59 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.1, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.13, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.44 } ] } ] }, { "description": "Hc Assay, Toxin Or Antitoxin", "code_information": [ { "code": "87230", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 126.36, "discounted_cash": 19, "minimum": 19.74, "maximum": 126.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.61, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.94, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 27.64, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28.82 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 27.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.92, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 30.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Glutathione", "code_information": [ { "code": "82978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 194, "discounted_cash": 15, "minimum": 14.54, "maximum": 194, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23.18, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 23.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.54 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bartonella, Antibody", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40, "discounted_cash": 10, "minimum": 7.24, "maximum": 40, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.27, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.31 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.75 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Urobilinogen Urine Quan Tmd Spec", "code_information": [ { "code": "84580", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 9.66, "discounted_cash": 9, "minimum": 2.898, "maximum": 9.66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.38 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.66, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assayof Estrogen Receptor", "code_information": [ { "code": "84233", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 286, "discounted_cash": 87, "minimum": 71.13, "maximum": 286, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 112.3, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 131.82, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 88.76, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 71.13 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 123.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 128.3 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 123.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 93.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 71.13 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 136.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 136.21, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 71.13 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 87.88, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 115.77, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Histamine", "code_information": [ { "code": "83088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 188.5, "discounted_cash": 29, "minimum": 29.53, "maximum": 188.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 37.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 44.3, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.83, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.11 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.52 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.23 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 31.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 45.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.12 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 29.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.9, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bcr/Abl1 Gene Minor Bp", "code_information": [ { "code": "81207", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1073.1, "discounted_cash": 144, "minimum": 72.3, "maximum": 1073.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 185.08, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 217.26, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 146.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 72.3 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 202.78, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 211.47 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 203.65 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 77.36 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 153.53, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 72.3 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 224.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 72.3 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 144.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 190.8, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vasopressin", "code_information": [ { "code": "84588", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 359.67, "discounted_cash": 33, "minimum": 33.94, "maximum": 359.67, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 43.37, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.91, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 34.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 47.52, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 49.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 47.72 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.04 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 52.61, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 34.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 33.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Lactic Acid", "code_information": [ { "code": "83605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 532.5, "discounted_cash": 11, "minimum": 10.8, "maximum": 532.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.89 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.27 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.56 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.26, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Bile Acids, Total", "code_information": [ { "code": "82239", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183, "discounted_cash": 17, "minimum": 16.71, "maximum": 183, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.68, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.29, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.07 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.88 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.15, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 26.54, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.71 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.12, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.55, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Hc Assay Of Vitamin B-2", "code_information": [ { "code": "84252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 351, "discounted_cash": 20, "minimum": 20.24, "maximum": 351, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Aetna Coventry Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.86, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Blue Shield Of CA", "plan_name": "Blue Shield Of VA", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.36, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "Caloptima", "plan_name": "Caloptima Medi-Cal IP", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Central Health Plan", "plan_name": "Central Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.55 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.46 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.08 }, { "payer_name": "Health Net of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net of CA", "plan_name": "Health Net of CA Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Innovative Mgmt Svcs", "plan_name": "Innovative Mgmt Svcs", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "MedCare Partners Health Plan", "plan_name": "MedCare Partners Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Residential Treatment Center", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Santa Ana - County Jail", "methodology": "fee schedule", "standard_charge_dollar": 31.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Patient Choice Health Plan", "plan_name": "Patient Choice Health Plan medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payer Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.64 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda HealthPlan", "plan_name": "Verda Healthplan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Workers Compensation", "plan_name": "Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.66, "additional_payer_n