{ "hospital_name": "Paradise Valley Hospital", "last_updated_on": "2026-03-17", "version": "3.0", "location_name": [ "Paradise Valley Hospital" ], "hospital_address": [ "2400 East Fourth Street National City, CA 91950" ], "license_information": { "license_number": "205837239", "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": "Neerav Jadeja" }, "type_2_npi": [ "1356410351", "1972679694", "1285064907" ], "standard_charge_information": [ { "description": "17 KETOSTEROIDS URINE LC", "code_information": [ { "code": "83586", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.5, "discounted_cash": 12, "minimum": 3.84, "maximum": 31.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 17.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.67 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.9, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 25.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.76, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 21.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.06 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.86, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "14.3.3ETA PROTEIN(RA)LC504550", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43, "discounted_cash": 17, "minimum": 5.181, "maximum": 365.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "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": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "2 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1886.68, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 779.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 2.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 605.56, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 2.62 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 917.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "17-OH PROGESTERONE LC70085", "code_information": [ { "code": "83498", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 135.85, "discounted_cash": 27, "minimum": 8.151, "maximum": 135.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 38.04, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.95 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 54.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 42.11, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 46.19, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 46.18 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 46.18 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 27.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 33.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "7 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 600, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 600, "additional_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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 600, "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": 600, "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": 2.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 2.62 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 600, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "3 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2179.12, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 2.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 605.56, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 2.62 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 917.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 779.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "5 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 400, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400, "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": 400, "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": 2.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 400, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB SCREEN", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.11, "discounted_cash": 66, "minimum": 2.98, "maximum": 337.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "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": 100.04, "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": 67.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 93.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "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": 93.77, "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": 3.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "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": 70.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 88.03, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 133.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 103.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "4 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 320, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320, "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": 320, "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": 2.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 320, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "4DRUG SPEC SUSC LC-AR 060201", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.25, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "A/C JNT DISLOC W/O MANIP", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.2, "discounted_cash": 315, "minimum": 189.04, "maximum": 1327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 473.55, "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": 318.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 226.85 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.92, "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": 443.87, "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": 202.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 334.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 631.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 489.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 415.89, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD 1VW", "code_information": [ { "code": "74018", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.13, "discounted_cash": 111, "minimum": 16.73, "maximum": 584.13, "payers_information": [ { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.08 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 17.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 99.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 99.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.73 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "7 NUT-PANEL, IGE- LC671926 - 86003 - 1323000", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "5-HIAA QUNT 24HR URINE LC4069", "code_information": [ { "code": "83497", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.9, "discounted_cash": 12, "minimum": 3.87, "maximum": 12.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 12.9, "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": 12.9, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 12.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 12.9 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.9, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB ELUTION 4.2-SDBB", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.22, "discounted_cash": 218, "minimum": 22.76, "maximum": 1057.25, "payers_information": [ { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 201.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 24.35 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5154.21, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "7 NUT-PANEL, IGE- LC671926 - 86003 - 1701071LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.22, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 5.22, "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": 5.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 5.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 5.22 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "6 AG SCREEN/UNIT RC", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 480, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 480, "additional_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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480, "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": 480, "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": 2.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 480, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 2.62 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 480, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB ELUTION RC", "code_information": [ { "code": "86860", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1057.25, "discounted_cash": 218, "minimum": 22.76, "maximum": 1057.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 278.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 305.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.31 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 272.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.35 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 283.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 272.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 287.83, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 436.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 337.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 370.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.76 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 218.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 272.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 287.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "A/C JNT DISLOC W/MANIP", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1035.2, "discounted_cash": 315, "minimum": 189.04, "maximum": 1327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 473.55, "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": 318.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 226.85 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.92, "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": 443.87, "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": 202.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 334.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 631.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 489.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 415.89, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "A FUMIGATUS PRECIP AB LC 66009", "code_information": [ { "code": "86606", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72.25, "discounted_cash": 15, "minimum": 4.515, "maximum": 72.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.42 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 30.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.59, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.6 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.35 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD PARACENTESIS(W/O IMAGING)", "code_information": [ { "code": "49082", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5550.21, "discounted_cash": 1160, "minimum": 58.45, "maximum": 5550.21, "payers_information": [ { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1529.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1483.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 1625.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 70.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1509.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 1532.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 2321.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.38, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABO TYPING RC", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.65, "discounted_cash": 170, "minimum": 2.73, "maximum": 780.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD COMP DECUB/ERECT VWS", "code_information": [ { "code": "74021", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.59, "discounted_cash": 133, "minimum": 25.06, "maximum": 718.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 200.7, "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": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 30.07 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "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": 188.12, "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": 26.81 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 176.62, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 189.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 189.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.06 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB ID", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2179.12, "discounted_cash": 458, "minimum": 18.96, "maximum": 2179.12, "payers_information": [ { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 605.56, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 917.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 779.89, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4539.67, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABD PARACENTESIS W/IMAGING", "code_information": [ { "code": "49083", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4805.38, "discounted_cash": 1160, "minimum": 89.72, "maximum": 5550.21, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1483.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 1625.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 107.66 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1509.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 1532.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 2321.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1799.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1973.38, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 89.72 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1160.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1451.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1529.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AB ID 4.2-SDBB", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 422.4, "discounted_cash": 458, "minimum": 18.96, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "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": 422.4, "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": 422.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "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": 422.4, "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": 20.29 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "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": 422.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "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": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "170.00% 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": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 422.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABLATE BONE TUMOR(S) PERQ - 20983 - 4400983", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9286, "minimum": 342.89, "maximum": 26107.8, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12234.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11866.61, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "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": 13930.46, "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": 9379.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13001.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 411.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13001.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13558.98, "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": 13057.48, "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": 366.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12073.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "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": 9844.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12258.8, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 18573.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14394.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15787.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17669.85, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6680.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AB ID/SELECT REAG. CELL RC", "code_information": [ { "code": "86885", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14, "discounted_cash": 218, "minimum": 4.2, "maximum": 66, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 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": 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": 14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.01 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% 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, "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": 14, "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": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14, "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": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "170.00% 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": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.73 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5975.15, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care 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 : 1", "code_information": [ { "code": "5641", "type": "APR-DRG" } ], "standard_charges": [ { "setting": "inpatient", "minimum": 2923.44, "maximum": 3128.08, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2923.44, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABLATE BONE TUMOR(S) PERQ - 20983 - 4220983", "code_information": [ { "code": "20983", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26107.8, "discounted_cash": 9286, "minimum": 342.89, "maximum": 26107.8, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11866.61, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "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": 13930.46, "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": 9379.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13001.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 411.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13001.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13558.98, "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": 13057.48, "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": 366.89 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12073.06, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "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": 9844.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12258.8, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 18573.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14394.8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15787.85, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 342.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9286.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 11608.71, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12234.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD AP/OBLIQUE/CONE VWS", "code_information": [ { "code": "74019", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.59, "discounted_cash": 133, "minimum": 20.14, "maximum": 718.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 200.7, "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": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.17 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "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": 188.12, "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": 21.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 176.62, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.46, "additional_payer_notes": "170.00% 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": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 189.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 189.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITHOUT D&C", "code_information": [ { "code": "779", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9119, "minimum": 5508.63, "maximum": 48414.572, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 16665.01 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 9119.48, "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": 9210.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 12767.27, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "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": 11855.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 11399.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 16524.5, "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": 13314.44, "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": 12821.99, "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": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 11855.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11399.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "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": 9666.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 11855.32, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 18238.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14135.19, "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": 14591.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15503.12, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5508.63 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9119.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17180.43 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 14390.43, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABO GROUP", "code_information": [ { "code": "86900", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 780.65, "discounted_cash": 170, "minimum": 2.73, "maximum": 780.65, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.28 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.73 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABD SERIES W/CHEST 1VW", "code_information": [ { "code": "74022", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 718.59, "discounted_cash": 133, "minimum": 36.75, "maximum": 718.59, "payers_information": [ { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 44.1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 195.35, "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": 188.12, "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": 39.32 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 173.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 141.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 176.62, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 267.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 207.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 227.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 167.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 176.26, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.97, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 36.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "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": 200.7, "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": 135.14, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 187.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 133.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ABRASION LESION SNGL - 15786 - 6500441", "code_information": [ { "code": "15786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316, "discounted_cash": 256, "minimum": 92.39, "maximum": 316, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 316, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 110.87 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "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": 316, "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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 272.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "170.00% 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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABRASION LESIONS EA 4 ADD - 15787 - 6510457", "code_information": [ { "code": "15787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "minimum": 14.95, "maximum": 200, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.94 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9671.72, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3970.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABRASION LESIONS EA 4 ADD - 15787 - 6500458", "code_information": [ { "code": "15787", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "minimum": 14.95, "maximum": 200, "payers_information": [ { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.94 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.95 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16 } ] } ] }, { "description": "ACETAMINOPHEN", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 904.31, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.74 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 151.05, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6403.11, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10145.16, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ABSCESS/FISTULA/SINUS - 76080 - 4006201", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2928.77, "discounted_cash": 699, "minimum": 32.37, "maximum": 2928.77, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 741.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 923.13, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 1398.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1083.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1188.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 378.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 378.27 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 874.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 921.28, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 893.6, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "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": 1049.01, "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": 706.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 979.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 874.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 874.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1021.04, "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": 983.27, "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": 34.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 909.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 874.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ACHR MODULATING ANTIBODIES", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 18, "minimum": 6.003, "maximum": 900, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 15.07 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.08 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABSCESS/FISTULA/SINUS - 76080 - 4102802", "code_information": [ { "code": "76080", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 721, "discounted_cash": 699, "minimum": 32.37, "maximum": 2928.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "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": 721, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 706.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 721, "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": 721, "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": 34.64 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "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": 721, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 378.27 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 378.27 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 699.34, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 721, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACETAMINOPHEN SCR LC", "code_information": [ { "code": "80329", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1.55, "minimum": 1, "maximum": 10, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 1.55 } ] } ] }, { "description": "ACOUS ELECTR CARDGRAPHY SINGLE", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 183.72, "discounted_cash": 164, "minimum": 55.116, "maximum": 408.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 183.72, "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": 166.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": 183.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "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": 183.72, "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": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 183.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY", "code_information": [ { "code": "770", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10680, "minimum": 9002.125, "maximum": 21360.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 19182.24 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 10680.32, "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": 10787.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 14952.45, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "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": 13884.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 13350.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 19352.74, "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": 15593.27, "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": 15016.53, "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": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 13884.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 13350.4, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "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": 11321.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 13884.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 21360.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 16554.5, "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": 17088.51, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 18156.54, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10251.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10680.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19775.5 } ] } ] }, { "description": "ACETONE/KEYTONES QUAN 1.1", "code_information": [ { "code": "82010", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.2, "discounted_cash": 8, "minimum": 7.56, "maximum": 48.11, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "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": 12.26, "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": 8.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.93 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.49 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "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": 8.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.34, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.76, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACROMIOCLAVICULAR DISLOC W/MAN", "code_information": [ { "code": "23545", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1327, "discounted_cash": 315, "minimum": 189.04, "maximum": 1327, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 473.55, "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": 318.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 226.85 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.92, "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": 443.87, "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": 202.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 334.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 631.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 489.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 189.04 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 415.89, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACETONE/KETONES QUAL", "code_information": [ { "code": "82009", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 82.01, "discounted_cash": 4, "minimum": 4.31, "maximum": 82.01, "payers_information": [ { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.17 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 4.61 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.88, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.97, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 4.31 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 9.04, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 7.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.95, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.78, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.31 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.33, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.52, "additional_payer_notes": "100.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3745.55, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACHR BINDING ABS, SERUM", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.88, "discounted_cash": 18, "minimum": 6.003, "maximum": 900, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 24.88, "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": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.08 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACETYL CHOL REC MODULATING AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 18, "minimum": 6.003, "maximum": 900, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 15.07 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.08 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 36.8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 28.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 31.28, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ABRASION LESION SNGL - 15786 - 6510440", "code_information": [ { "code": "15786", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 316, "discounted_cash": 256, "minimum": 92.39, "maximum": 316, "payers_information": [ { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 316, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 259.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 110.87 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "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": 316, "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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 272.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "170.00% 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": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 256.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 316, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 92.39 } ] } ] }, { "description": "ACID FAST SMEAR LC182675,18240", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.13, "discounted_cash": 5, "minimum": 1.725, "maximum": 92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 8.09, "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": 5.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "170.00% 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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13200.37, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACID FAST SMEAR", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 92, "discounted_cash": 5, "minimum": 1.725, "maximum": 92, "payers_information": [ { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 8.09, "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": 5.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "170.00% 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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AC JOINTS BIL", "code_information": [ { "code": "73050", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 413, "discounted_cash": 111, "minimum": 26.75, "maximum": 413, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32.1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 28.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18754.23, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3331.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACID FAST SMEAR+CULT LC183764", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.13, "discounted_cash": 5, "minimum": 1.725, "maximum": 92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 8.09, "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": 5.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.6 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.87 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.58 }, { "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.01, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.11, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.35, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.16, "additional_payer_notes": "170.00% 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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.1, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACELLULAR DERM ALLOGR FACE,SCA", "code_information": [ { "code": "15277", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4705.29, "discounted_cash": 2640, "minimum": 177.21, "maximum": 4705.29, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3374.23, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 3961.08, "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": 2667.13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 3697.01, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 212.65 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 3300.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3855.45, "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": 189.61 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 3432.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 3300.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 3485.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 177.21 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4705.29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4093.12, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4489.22, "additional_payer_notes": "170.00% 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": 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 177.21 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 2640.72, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 3300.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 3478.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION", "code_information": [ { "code": "880", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 10269, "minimum": 5936, "maximum": 20538.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 17089.31 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 10269.32, "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": 10371.99, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 14377.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "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": 13350.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 12836.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18608.01, "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": 14993.21, "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": 14438.66, "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": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 13350.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12836.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "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": 10885.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 13350.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 20538.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15917.45, "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": 16430.91, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 17457.84, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7888.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 10269.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17617.84 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4873.28, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACOUS ELECTR CARD MULTI AV+VV", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 55.116, "maximum": 408.96, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 217.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACETYL CHOL REC BLOCKING AB", "code_information": [ { "code": "83519", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.88, "discounted_cash": 18, "minimum": 6.003, "maximum": 900, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 24.24, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.51, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 24.88, "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": 18.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.88 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.07 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.29, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.08 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.88, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.97 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.08 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4969.75, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE HEP PNL LC322355", "code_information": [ { "code": "80074", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 275.06, "discounted_cash": 47, "minimum": 40, "maximum": 275.06, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 60.86, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "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": 71.45, "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": 48.11, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 48 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.68, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.54 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 66.97 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 42.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 61.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "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": 50.49, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 62.87, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 95.26, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 73.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80.97, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 80.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 80.96 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.63, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 59.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "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": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 49.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 54.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 47.27 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.98, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 77.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.86, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 65.65, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 65.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 65.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 39.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 38.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 48.28, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 50.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACID FAST SMEAR LC 188243", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.75, "discounted_cash": 5, "minimum": 1.725, "maximum": 92, "payers_information": [ { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "170.00% 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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.75, "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": 5.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7029.52, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8886.82, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACID FAST STAIN", "code_information": [ { "code": "87206", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6.5, "discounted_cash": 5, "minimum": 1.725, "maximum": 92, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 6.5, "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": 5.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "170.00% 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": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5463.76, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 17070.79, "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": 27154, "minimum": 23469.875, "maximum": 54308.54, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 48695.43 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 27154.27, "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": 27425.84, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 38015.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "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": 35300.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 33942.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 49203.54, "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": 39645.23, "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": 38178.9, "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": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 35300.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 33942.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "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": 28783.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 35300.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 54308.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 42089.12, "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": 43446.83, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 46162.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 35907.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 27154.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 50201.47 } ] } ] }, { "description": "ACOUS ELECTR CARD MULTI AV/VV", "code_information": [ { "code": "93799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 408.96, "discounted_cash": 164, "minimum": 55.116, "maximum": 408.96, "payers_information": [ { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 214.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 217.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 329.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 255.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 279.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 216.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 210.42, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 230.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 205.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 164.68, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45078.63, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15211.37, "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": 9974, "minimum": 9974.36, "maximum": 25316.536, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 17452.98 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 9974.36, "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": 10074.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 13964.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "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": 12966.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 12467.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 18073.54, "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": 14562.57, "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": 14023.95, "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": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 12966.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12467.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "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": 10572.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 12966.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 19948.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15460.26, "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": 15958.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16956.41, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 13050.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9974.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 17992.77 } ] } ] }, { "description": "ACTINOMYCES AB", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 10, "minimum": 3.978, "maximum": 25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 20.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "836", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12776, "minimum": 10800, "maximum": 94740.796, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 22653.22 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 12776.92, "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": 12904.67, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 17887.69, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "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": 16610, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 15971.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 23151.78, "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": 18654.3, "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": 17964.35, "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": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 16610, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15971.15, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "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": 13543.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 16610, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 25553.84, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19804.23, "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": 20443.07, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21720.76, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16939 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12776.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23353.84 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25746.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10975.22, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8140.51, "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": 8582, "minimum": 3718.05, "maximum": 17165.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 12092.3 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 8582.76, "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": 8668.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 12015.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "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": 11157.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 10728.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15551.96, "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": 12530.83, "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": 12067.36, "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": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 11157.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10728.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "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": 9097.73, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 11157.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 17165.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13303.28, "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": 13732.42, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14590.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 3718.05 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8582.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12466.29 } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC", "code_information": [ { "code": "835", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 21154, "minimum": 16768.125, "maximum": 42309.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 38077.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 21154.6, "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": 21366.15, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 29616.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "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": 27500.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 26443.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 38332.14, "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": 30885.72, "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": 29743.37, "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": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 27500.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 26443.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "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": 22423.88, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 27500.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 42309.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 32789.63, "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": 33847.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 35962.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24234.6 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 21154.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39255.11 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6782.52, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9819.71, "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": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7316.81, "additional_payer_notes": "100% 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" } ] } ] }, { "description": "ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC", "code_information": [ { "code": "834", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 54074, "minimum": 28679.75, "maximum": 109363, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 98537.16 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 54074.46, "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": 54615.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 75704.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "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": 70296.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 67593.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 97982.92, "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": 78948.71, "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": 76028.69, "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": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 70296.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 67593.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "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": 57318.97, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 70296.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 108148.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 83815.41, "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": 86519.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 91926.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 109363 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 54074.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 101584.7 } ] } ] }, { "description": "ACUTE HEP PNL", "code_information": [ { "code": "86709", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.03, "discounted_cash": 11, "minimum": 3.378, "maximum": 65.03, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "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": 16.89, "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": 11.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.64 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.83 }, { "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": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.64, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "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": 11.94, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.86, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "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": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 22.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.45, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.14, "additional_payer_notes": "170.00% 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": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 19.14 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.83, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE AND SUBACUTE ENDOCARDITIS WITH CC", "code_information": [ { "code": "289", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17490, "minimum": 9248.29, "maximum": 34980.78, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 28108.4 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 17490.39, "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": 17665.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 24486.55, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "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": 22737.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 21862.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31692.59, "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": 25535.97, "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": 24591.49, "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": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 22737.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21862.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "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": 18539.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 22737.51, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 34980.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27110.1, "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": 27984.62, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29733.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9248.29 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17490.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 28977.73 } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CCMCC", "code_information": [ { "code": "282", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7976, "minimum": 7650, "maximum": 39061.376, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 15952.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12363.44, "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": 12762.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13559.9, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11062.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13326.41 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 12926.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7976.41, "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": 8056.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 11166.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "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": 10369.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 9970.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14453.25, "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": 11645.56, "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": 11214.83, "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": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 10369.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9970.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8454.99, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 10369.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7976.41, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4013.54, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3855.58, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, EXPIRED WITH CC", "code_information": [ { "code": "284", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7677, "minimum": 7200, "maximum": 15355.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 13210.07 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7677.58, "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": 7754.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 10748.61, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "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": 9980.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 9596.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13911.77, "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": 11209.27, "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": 10794.68, "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": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9980.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9596.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "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": 8138.23, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 9980.85, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 15355.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11900.25, "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": 12284.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13051.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 9877.57 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7677.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 13618.63 } ] } ] }, { "description": "ADENOSINE DEAMINASE,PLEURAL LC", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 8, "minimum": 7.44, "maximum": 124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 12.15, "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": 8.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9493.2, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10920.09, "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": 6775, "minimum": 5850, "maximum": 43636.416, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12276.86, "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": 9891.95, "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": 9526.09, "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": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 8807.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8469.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "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": 7181.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 8807.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 13550.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10501.73, "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": 10840.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11518.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7484.14 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10317.81 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 10008.28 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 6775.31, "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": 6843.06, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 9485.43, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "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": 8807.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 8469.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 6775.31, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS AB LC 096065", "code_information": [ { "code": "86603", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.14, "discounted_cash": 12, "minimum": 3.942, "maximum": 13.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 13.14, "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": 13, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 13.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 13.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.14 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.14, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC", "code_information": [ { "code": "280", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 16496, "minimum": 12637.625, "maximum": 32992.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 29261.83 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 16496.25, "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": 16661.26, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 23094.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "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": 21445.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 20620.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 29891.21, "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": 24084.53, "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": 23193.73, "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": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 21445.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 20620.31, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "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": 17486.08, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 21445.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 32992.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 25569.19, "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": 26394, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 28043.63, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18294.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 16496.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 30166.83 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8594.23, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADAMTS 13 LC117913", "code_information": [ { "code": "85397", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 178.22, "discounted_cash": 30, "minimum": 24.68, "maximum": 178.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 39.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "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": 46.29, "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": 31.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.62 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 43.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 45.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 43.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.41 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.12, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "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": 32.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.74, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 61.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 47.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 24.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 30.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 38.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.65, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2180.63, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care 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": 20139, "minimum": 9517.75, "maximum": 40278.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 34859.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 20139.18, "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": 20340.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 28194.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "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": 26180.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 25173.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 36492.19, "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": 29403.2, "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": 28315.69, "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": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 26180.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 25173.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "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": 21347.55, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 26180.93, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 40278.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 31215.73, "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": 32222.69, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 34236.61, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 33958.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 20139.2, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35937.75 } ] } ] }, { "description": "ACUTE MAJOR EYE INFECTIONS WITH CCMCC", "code_information": [ { "code": "121", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12233, "minimum": 5798.05, "maximum": 26091.532, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 20736.78 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 12233.43, "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": 12355.73, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 17126.8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "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": 15903.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 15291.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22166.98, "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": 17860.81, "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": 17200.2, "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": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 15903.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15291.79, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "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": 12967.4, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 15903.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 24466.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18961.82, "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": 19573.49, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20796.83, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5798.05 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12233.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21378.13 } ] } ] }, { "description": "ADAMTS13 INHIBITOR LC", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 121, "discounted_cash": 12, "minimum": 12.87, "maximum": 121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8638.75, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6639.41, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AERO/NEB/MDI/IPPB EVAL", "code_information": [ { "code": "94664", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1114.74, "discounted_cash": 280, "minimum": 12.34, "maximum": 1114.74, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 13.2 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 369.94, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 12.34 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 560.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.34 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADENOVIRUS DFA, PEDS", "code_information": [ { "code": "87260", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 14, "minimum": 11.59, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.44, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "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": 21.65, "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": 14.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.91 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 20.29 }, { "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": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "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": 15.3, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.05, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "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": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 28.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.53, "additional_payer_notes": "170.00% 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": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.01, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15137.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 24086.53, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AERO/NEB/MDI/IPPB TX - 94640 - 6011076", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.14, "discounted_cash": 280, "minimum": 16.78, "maximum": 1287.52, "payers_information": [ { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 369.94, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 559.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.44, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 } ] } ] }, { "description": "ADENOVIRUS PCR LC815931", "code_information": [ { "code": "87799", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 170, "discounted_cash": 42, "minimum": 32.988, "maximum": 214.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "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": 64.26, "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": 43.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 52.44 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 62.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 60.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.76 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 55.69, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "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": 45.41, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 56.55, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 85.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 66.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 72.83, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 72.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 42.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 53.55, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 56.44, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC", "code_information": [ { "code": "281", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9871, "minimum": 9871.85, "maximum": 19743.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 16433.26 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 9871.85, "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": 9970.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 13820.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "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": 12833.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 12339.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17887.79, "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": 14412.9, "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": 13879.82, "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": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 12833.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 12339.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "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": 10464.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 12833.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 19743.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 15301.37, "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": 15794.96, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16782.15, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 12333.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9871.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16941.5 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 45294.89, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB PCR-TBCDNA, UWSH", "code_information": [ { "code": "87556", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 219.19, "discounted_cash": 41, "minimum": 19.8, "maximum": 409, "payers_information": [ { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 52.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 58.6 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 54.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "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": 44.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 55.02, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 64.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 70.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 52.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 54.91, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.26, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "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": 62.52, "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": 42.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.91 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 38.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 58.35, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 52.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 38.26 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2936.48, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ADAMS TS-13 ARUP 92177", "code_information": [ { "code": "85335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86, "discounted_cash": 12, "minimum": 12.87, "maximum": 121, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.44, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 18.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.76 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.73, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.99, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 25.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.88, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 21.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.13 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.87, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.95, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE WITH CCMCC", "code_information": [ { "code": "949", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12488, "minimum": 8630.875, "maximum": 29624.3, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 19235.72 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 12488.73, "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": 12613.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 17484.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "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": 16235.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 15610.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22629.58, "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": 18233.55, "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": 17559.15, "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": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 16235.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15610.91, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "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": 13238.02, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 16235.35, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 24977.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19357.53, "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": 19981.97, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21230.84, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29624.3 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12488.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 19830.64 } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "615", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 14515, "minimum": 6750, "maximum": 68771.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 25546.6 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 14515.7, "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": 14660.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 20321.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "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": 18870.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 18144.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26302.45, "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": 21192.92, "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": 20409.07, "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": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 18870.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18144.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "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": 15386.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 18870.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 29031.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22499.34, "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": 23225.12, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24676.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 19799.6 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14515.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26336.71 } ] } ] }, { "description": "ADAMTS13 AB LC", "code_information": [ { "code": "83520", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 152, "discounted_cash": 17, "minimum": 5.181, "maximum": 365.32, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.91, "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": 17.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 24.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 18.31, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.8, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 34.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.01 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.27, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 21.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADSORPTION,EACH RC", "code_information": [ { "code": "86978", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 75, "minimum": 22.5, "maximum": 199, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 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": 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": 75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 27.5 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 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": 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": 24.52 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC", "code_information": [ { "code": "560", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 11873, "minimum": 11053.625, "maximum": 23747.36, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 20300.01 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 11873.68, "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": 11992.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 16623.15, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "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": 15435.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 14842.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21515.11, "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": 17335.57, "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": 16694.39, "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": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 15435.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 14842.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "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": 12586.12, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 15435.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 23747.36, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18404.2, "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": 18997.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20185.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.68, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18730.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 11873.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20927.85 } ] } ] }, { "description": "ADVANTAGE AMBULANCE SERVICES", "code_information": [ { "code": "A0429", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 226.59, "discounted_cash": 528, "minimum": 67.977, "maximum": 226.59, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "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": 226.59, "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": 226.59, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 141.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 226.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 126.47 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "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": 226.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 118.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 226.59, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AEROBIC ORG. IDENTIFICATION LC", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21, "discounted_cash": 8, "minimum": 2.586, "maximum": 221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 12.93, "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": 8.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 9.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "170.00% 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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC", "code_information": [ { "code": "559", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 19018, "minimum": 15483.875, "maximum": 38036.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 33092.93 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 19018.36, "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": 19208.58, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 26625.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "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": 24723.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 23772.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34461.27, "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": 27766.81, "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": 26739.81, "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": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 24723.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23772.95, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "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": 20159.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 24723.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 38036.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29478.46, "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": 30429.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32331.21, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.36, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 24745 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19018.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 34116.42 } ] } ] }, { "description": "AEROBIC BACT CULTURE LC008649", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 43.1, "discounted_cash": 8, "minimum": 2.586, "maximum": 221, "payers_information": [ { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 9.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "170.00% 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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 12.93, "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": 8.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 } ] } ] }, { "description": "ADENO DEAM PERICARD LC830932", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 60, "discounted_cash": 8, "minimum": 7.44, "maximum": 124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 12.15, "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": 8.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AEROBIC/ANAEROBIC CULTURE LC", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 49.78, "discounted_cash": 8, "minimum": 2.586, "maximum": 221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 12.93, "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": 8.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.59 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 12.12 }, { "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.21, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 9.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.24, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.65, "additional_payer_notes": "170.00% 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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.36, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CCMCC", "code_information": [ { "code": "561", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 8757, "minimum": 8757.8, "maximum": 28097.056, "payers_information": [ { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9283.27, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 11385.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 17515.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 13574.59, "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": 14012.48, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 14888.26, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 11998.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 15026.44 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 14575.65 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 8757.8, "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": 8845.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 12260.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "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": 11385.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 10947.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 15869.13, "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": 12786.39, "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": 12313.47, "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": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 11385.14, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 10947.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 8757.8, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AEROBIC ORG. ID+SENS LC", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 46.66, "discounted_cash": 8, "minimum": 2.424, "maximum": 172.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 12.12, "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": 8.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "170.00% 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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADENO DEAM PLEURAL LC830932", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80.85, "discounted_cash": 8, "minimum": 7.44, "maximum": 124, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 12.15, "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": 8.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB ID BY DNA PROBE LC008694", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100.25, "discounted_cash": 20, "minimum": 12.99, "maximum": 100.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "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": 30.08, "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": 20.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "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": 21.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AG TYPE/UNIT", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2179.12, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 2.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 605.56, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 2.62 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 917.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 711.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 779.89, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB DNA ID LC183802", "code_information": [ { "code": "87149", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 83.24, "discounted_cash": 20, "minimum": 12.99, "maximum": 100.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "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": 30.08, "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": 20.25, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.59 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 29.27 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 28.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.9 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "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": 21.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 26.47, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 40.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 31.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 34.09, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 34.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.99 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 20.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 25.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFP W/AFP-L3 LC141300", "code_information": [ { "code": "82107", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 75, "discounted_cash": 64, "minimum": 22.5, "maximum": 75, "payers_information": [ { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 65.05, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.97 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.81 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 64.41, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 75, "additional_payer_notes": "170.00% of Medicare Rates" } ] } ] }, { "description": "AG TYPE/UNIT, PT SERUM RC", "code_information": [ { "code": "86904", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 197.68, "discounted_cash": 75, "minimum": 7.85, "maximum": 197.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 96.47, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 105.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.42 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 8.4 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 98.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 99.66, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 7.85 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 151, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 117.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 128.35, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 16.16 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 75.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 94.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 99.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB RAPID GROW", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 173.25, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADENOSINE DEAMINASE LC830896", "code_information": [ { "code": "84311", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 8, "minimum": 7.44, "maximum": 124, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.35, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 12.15, "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": 8.18, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.93 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.34, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.53, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "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": 8.59, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.69, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.56, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.88 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 5442.55, "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": 7053, "minimum": 7053.83, "maximum": 23650.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 10448.61 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7053.83, "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": 7124.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 9875.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "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": 9169.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 8817.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12781.54, "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": 10298.59, "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": 9917.68, "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": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9169.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8817.29, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "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": 7477.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 9169.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 14107.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10933.44, "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": 11286.13, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11991.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 23650.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7053.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 10771.77 } ] } ] }, { "description": "AGGLUTININS FEBRILE 1.5", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.55, "discounted_cash": 6, "minimum": 3.765, "maximum": 17.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ADRENAL AND PITUITARY PROCEDURES WITH CCMCC", "code_information": [ { "code": "614", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 22179, "minimum": 12150, "maximum": 44359.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 40628.55 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 22179.69, "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": 22401.5, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 31051.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "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": 28833.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 27724.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 40189.6, "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": 32382.35, "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": 31184.64, "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": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 28833.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 27724.61, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "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": 23510.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 28833.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 44359.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 34378.52, "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": 35487.5, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 37705.47, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 32649.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22179.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 41885.1 } ] } ] }, { "description": "AICD DEVICE INTERROGATION", "code_information": [ { "code": "93289", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 276.43, "discounted_cash": 47, "minimum": 20.95, "maximum": 293, "payers_information": [ { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 66.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 69.73, "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": 67.15, "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": 22.42 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "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": 50.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.04, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 95.52, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.03, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.19, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 59.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.92, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.03, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.95 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "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": 71.64, "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": 48.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 66.86, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.76, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AIRFLOW RESISTANCE", "code_information": [ { "code": "94726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.49, "discounted_cash": 477, "minimum": 37.99, "maximum": 746.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 610.25, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "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": 716.39, "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": 482.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 668.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 45.59 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 668.63, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 596.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 697.28, "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": 671.49, "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": 40.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 620.87, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 596.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "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": 506.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 630.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 746.49, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 740.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 746.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.99 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 477.59, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 596.99, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 629.15, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10090.03, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AICD LEAD PROCEDURES", "code_information": [ { "code": "265", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 35973, "minimum": 18450, "maximum": 120852.048, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 63593.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 35973.91, "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": 36333.64, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 50363.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "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": 46766.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 44967.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 65184.72, "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": 52521.91, "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": 50579.32, "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": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 46766.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 44967.39, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "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": 38132.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 46766.08, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 71947.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 55759.56, "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": 57558.26, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 61155.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.91, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47551.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 35973.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 65560.57 } ] } ] }, { "description": "ALANINE AMINO (ALT) (SGPT) LC", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.97, "discounted_cash": 5, "minimum": 1.671, "maximum": 154.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 7.95, "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": 5.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.31 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS FEBRILE 1.1", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17.18, "discounted_cash": 6, "minimum": 3.765, "maximum": 17.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13076.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALBUMIN BODY FLUID", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24, "discounted_cash": 7, "minimum": 2.334, "maximum": 44.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 11.67, "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": 7.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS FEBRILE 1.2DEL", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.55, "discounted_cash": 6, "minimum": 3.765, "maximum": 17.18, "payers_information": [ { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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" } ] } ] }, { "description": "ALCOHOL", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 660.83, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 160.2, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.74 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 148.76, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 151.05, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 228.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 177.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 194.53, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 143.04, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 150.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AGGLUTININS FEBRILE 1.3", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.55, "discounted_cash": 6, "minimum": 3.765, "maximum": 17.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN SERUM", "code_information": [ { "code": "82040", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 105.11, "discounted_cash": 4, "minimum": 1.485, "maximum": 105.11, "payers_information": [ { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.44, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 9.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.67, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.41 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.52, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.53 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.61 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18947.17, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AGGLUTININS FEBRILE 1.4", "code_information": [ { "code": "86000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.55, "discounted_cash": 6, "minimum": 3.765, "maximum": 17.18, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.92, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.21, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.2, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AERO/NEB/MDI/IPPB TX - 94640 - 3600350", "code_information": [ { "code": "94640", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 559.14, "discounted_cash": 280, "minimum": 16.78, "maximum": 1287.52, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 358.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 392.36, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 364.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 369.94, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 559.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 434.4, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 476.44, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.78 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 280.26, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 350.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 369.2, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3288.43, "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": 6949, "minimum": 4452, "maximum": 13898.76, "payers_information": [ { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 9729.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "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": 9034.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 8686.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 12592.28, "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": 10146.09, "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": 9770.83, "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": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9034.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 8686.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "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": 7366.34, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 9034.19, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 13898.76, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 10771.54, "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": 11119.01, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 11813.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 4633.15 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 6949.38, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 11470.16 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 11126.05 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 6949.38, "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": 7018.87, "additional_payer_notes": "101.00% of Medicare Rates" } ] } ] }, { "description": "AEROBIC CULTURE LC", "code_information": [ { "code": "87070", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.62, "discounted_cash": 8, "minimum": 2.586, "maximum": 221, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "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": 8.62, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "170.00% 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": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4746.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALDOSTERONE LC000703", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.75, "discounted_cash": 40, "minimum": 12.225, "maximum": 235.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 40.75, "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": 40.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 40.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 40.75 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 40.75 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AEROBIC/ANAEROBIC ID LC", "code_information": [ { "code": "87077", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65, "discounted_cash": 8, "minimum": 2.424, "maximum": 172.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 12.12, "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": 8.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "170.00% 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": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6415.73, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALDOSTERONE LC004374", "code_information": [ { "code": "82088", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 235.33, "discounted_cash": 40, "minimum": 12.225, "maximum": 235.33, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 57.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.87 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 53.79, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 81.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 69.28, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 69.26 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 69.26 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.56 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 50.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 53.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN BODY FLUID 1.1 LC 8277", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 7, "minimum": 2.334, "maximum": 44.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 11.67, "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": 7.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB NOCARDIA SUSCEPT", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 189, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 } ] } ] }, { "description": "ALCOHOLS - 80320 - 7100100A15", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "minimum": 3, "maximum": 36.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 } ] } ] }, { "description": "ALLERGEN IMMUNOTHRPY 2+", "code_information": [ { "code": "95117", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "discounted_cash": 59, "minimum": 9.45, "maximum": 111.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.11 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 79.09, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 111.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALBUMIN, BODY FLUID LC", "code_information": [ { "code": "82042", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 44.93, "discounted_cash": 7, "minimum": 2.334, "maximum": 44.93, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.94, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 11.67, "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": 7.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.94 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.11, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "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": 8.25, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.06, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.25 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.25, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB BLOOD CULTURE ARUP", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 66.6, "discounted_cash": 10, "minimum": 3.423, "maximum": 222, "payers_information": [ { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.56 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 11.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.23, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 16.2, "additional_payer_notes": "150.00% of Medicare Rates" } ] } ] }, { "description": "ALDOLASE LC", "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": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.82, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 19.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.51, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 16.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 12.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.79, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PANEL MIA LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 28.75, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AFB CULT LC183071", "code_information": [ { "code": "87116", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.37, "discounted_cash": 10, "minimum": 3.423, "maximum": 222, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 16.2, "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": 10.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.56 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.12, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.18 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.2 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.04, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "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": 11.45, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.26, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 21.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 18.36 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN EACH LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.1, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PANEL ZONE 19 LC - 86003 - 1700185", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4532.99, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB PCR ID LC183166", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35.09, "discounted_cash": 35, "minimum": 10.527, "maximum": 202.13, "payers_information": [ { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "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": 35.09, "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": 35.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "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": 35.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 35.09 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 } ] } ] }, { "description": "ALLERGEN, SPECIAL EACH", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.25, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PERENNIAL PANEL LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77.5, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": "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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6860.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AFB PCR ID, LC183166", "code_information": [ { "code": "87150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 202.13, "discounted_cash": 35, "minimum": 10.527, "maximum": 202.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 44.84, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "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": 52.64, "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": 35.44, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.13 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 49.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 51.23 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 49.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.73 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 45.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "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": 37.2, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 46.32, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 70.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 54.39, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 59.65, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.44 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 35.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 43.86, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 46.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 55309.66, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15162.61, "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": 14673, "minimum": 8838.78, "maximum": 34200, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 25812.23 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 14673.33, "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": 14820.03, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 20542.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "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": 19075.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 18341.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26588.07, "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": 21423.06, "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": 20630.7, "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": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 19075.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18341.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "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": 15553.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 19075.33, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 29346.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22743.66, "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": 23477.33, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24944.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.33, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8838.78 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14673.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26610.55 } ] } ] }, { "description": "AFB PCR-NTMDNA, UWSH", "code_information": [ { "code": "87551", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 330.86, "discounted_cash": 48, "minimum": 43.85, "maximum": 330.86, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 59.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.55, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.64, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "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": 72.36, "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": 48.72, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 67.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 52.62 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.54, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.43 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 67.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.71, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 60.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "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": 51.13, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.68, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 96.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 82.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 48.24, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALPHA-2 MACROGLOB LC122135", "code_information": [ { "code": "83883", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.96, "discounted_cash": 13, "minimum": 4.788, "maximum": 84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 15.96, "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": 13.74, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.84 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "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": 14.42, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 15.96 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLGN SPEC IGE EA 1.2", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": 17859, "minimum": 10176, "maximum": 35719.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 31746.96 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 17859.81, "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": 18038.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 25003.73, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "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": 23217.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 22324.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 32361.98, "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": 26075.32, "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": 25110.89, "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": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 23217.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 22324.76, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "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": 18931.39, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 23217.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 35719.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 27682.71, "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": 28575.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 30361.68, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 14078.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17859.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 32728.82 } ] } ] }, { "description": "ALPHA-FETOPROT SERUM", "code_information": [ { "code": "82105", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 96.85, "discounted_cash": 16, "minimum": 16.77, "maximum": 96.85, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.43, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 23.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 96.85 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.14, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 96.85 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 33.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.99, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 28.51, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 28.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 96.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 20.96, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.09, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 66446.01, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC", "code_information": [ { "code": "897", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9520, "minimum": 6996, "maximum": 19041.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 15727.3 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 9520.81, "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": 9616.02, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 13329.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "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": 12377.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 11901.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17251.71, "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": 13900.38, "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": 13386.26, "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": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 12377.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11901.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "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": 10092.06, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 12377.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 19041.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14757.26, "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": 15233.3, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 16185.38, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9520.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16213.71 } ] } ] }, { "description": "ALPHA1-ANTITRP PHENO LC", "code_information": [ { "code": "82104", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.46, "discounted_cash": 14, "minimum": 4.338, "maximum": 14.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 14.46, "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": 14.46, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 14.46, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.46 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "170.00% 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": 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.46, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALPHA-FETOPROT AMNIO LC002428", "code_information": [ { "code": "82106", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17, "discounted_cash": 17, "minimum": 5.1, "maximum": 17, "payers_information": [ { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "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": 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 17, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.56 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17, "additional_payer_notes": "125.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4881.76, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4892.36, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19238.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMIKACIN LEVEL-QUEST", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 87.4, "discounted_cash": 15, "minimum": 9.942, "maximum": 87.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.64, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALCOHOLS - G0480 - 7100100A15", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_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, "additional_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, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "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": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "155.00% of Medicare Rates" } ] } ] }, { "description": "AICD GENERATOR PROCEDURES", "code_information": [ { "code": "245", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 45104, "minimum": 19350, "maximum": 90209.86, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 87118.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 45104.93, "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": 45555.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 63146.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "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": 58636.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 56381.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 81730.13, "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": 65853.2, "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": 63417.53, "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": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 58636.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 56381.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "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": 47811.19, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 58636.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 90209.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 69912.64, "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": 72167.89, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 76678.38, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 65141.6 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 45104.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 89813.13 } ] } ] }, { "description": "AMINO ACID QUAN EA 1.2", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.98, "discounted_cash": 22, "minimum": 6.894, "maximum": 22.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 22.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 22.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMIKACIN LC", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.14, "discounted_cash": 15, "minimum": 9.942, "maximum": 87.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.64, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPHET CONFIRM QUEST - 80324 - 1350991", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.74, "minimum": 3.183, "maximum": 130.74, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.38 } ] } ] }, { "description": "ALLERGEN IMMUNOTHRPY SNGL", "code_information": [ { "code": "95115", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 111.09, "discounted_cash": 59, "minimum": 7.03, "maximum": 111.09, "payers_information": [ { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 83.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.44 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.52 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 77.9, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 79.09, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 111.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 92.88, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 101.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 59.92, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 74.9, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 78.94, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 76.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.03 } ] } ] }, { "description": "AMITRIPTYLINE LC7476 - 80335 - 1701853", "code_information": [ { "code": "80335", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8, "minimum": 2.4, "maximum": 32.06, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8 } ] } ] }, { "description": "AMPHET CONFIRM QUEST - G0480 - 1350991", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 130.74, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 130.74, "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": 115.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 76.74 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 130.74 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 95.93 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 63.95 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 114.43, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 130.74, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN PANEL A LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 221.25, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3856.64, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMMONIA - 82140 - 17400150C", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.57, "discounted_cash": 14, "minimum": 4.371, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 14.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 14.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.57 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "170.00% 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": 14.57, "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINES CONF UR LC71282 - 80324 - 1715309", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.7, "minimum": 3.183, "maximum": 130.74, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 } ] } ] }, { "description": "ALLERGEN PANEL ZONE 19 LC - 86003 - 17400185", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 116, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8305.88, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION TOE IP JT - 28825 - 6500813", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4049.82, "discounted_cash": 4187, "minimum": 290.51, "maximum": 4049.82, "payers_information": [ { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 4049.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 348.61 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 310.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 } ] } ] }, { "description": "ALLERGEN, FOOD-FISH LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.22, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 5.22, "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": 5.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 5.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 5.22 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 19303.36, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANA TITER ARUP 50174", "code_information": [ { "code": "86039", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13.5, "discounted_cash": 11, "minimum": 4.05, "maximum": 13.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 11.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.5, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2829.41, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9753.98, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANAEROBIC ORG. IDENTIFICATI LC", "code_information": [ { "code": "87076", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 24.44, "discounted_cash": 8, "minimum": 7.332, "maximum": 112, "payers_information": [ { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.89 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.36 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.82 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 8.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 16.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.52, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 13.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.64, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.32, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.24 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "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": 12.12, "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": 8.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "100.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8023.9, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPHETAMINES", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54, "minimum": 3.183, "maximum": 130.74, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.38 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8216.84, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLG SPEC IGE CRUDE XTRC EA LC", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.22, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 5.22, "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": 5.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 5.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 5.22 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.22 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGEN SPECIFIC IGE", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.87, "additional_payer_notes": "170.00% 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" } ] } ] }, { "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": 28549, "minimum": 19035.5, "maximum": 57099.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 51916.83 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 28549.75, "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": 28835.3, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 39969.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "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": 37114.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 35687.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 51732.15, "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": 41682.64, "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": 40140.95, "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": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 37114.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 35687.19, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "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": 30262.79, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 37114.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 57099.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 44252.11, "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": 45679.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 48534.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25027.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 28549.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 53522.51 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12875.97, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 89273.14, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4082.45, "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": 22991, "minimum": 22991.06, "maximum": 45982.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 38458.96 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 22991.06, "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": 23221.01, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 32187.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "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": 29888.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 28738.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 41659.8, "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": 33566.95, "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": 32325.43, "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": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 29888.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28738.83, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "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": 24370.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 29888.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 45982.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 35636.14, "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": 36785.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39084.8, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 25110.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 22991.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 39648.41 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "349", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 9402, "minimum": 7650, "maximum": 30063.14, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 15704.12 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 9402.83, "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": 9496.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 13163.96, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "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": 12223.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 11753.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 17037.93, "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": 13728.13, "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": 13220.38, "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": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 12223.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 11753.54, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "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": 9967, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 12223.68, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 18805.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 14574.39, "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": 15044.53, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 15984.81, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8862.79 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 9402.83, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 16189.81 } ] } ] }, { "description": "ALT-SGPT, LC001545", "code_information": [ { "code": "84460", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.5, "discounted_cash": 5, "minimum": 1.671, "maximum": 154.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 7.95, "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": 5.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.31 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.42, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.74 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.63 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "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": 5.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.01, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.26 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITH MCC", "code_information": [ { "code": "915", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 17245, "minimum": 9161.625, "maximum": 34491.46, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 30982.17 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 17245.73, "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": 17418.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 24144.02, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "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": 22419.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 21557.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 31249.26, "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": 25178.77, "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": 24247.5, "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": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 22419.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 21557.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "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": 18280.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 22419.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 34491.46, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 26730.88, "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": 27593.17, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 29317.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.73, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18491.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 17245.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 31940.38 } ] } ] }, { "description": "AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CCMCC", "code_information": [ { "code": "476", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12396, "minimum": 10332.7, "maximum": 24793.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 20735 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 12396.86, "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": 12520.87, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 17355.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "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": 16115.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 15496.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 22463.11, "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": 18099.42, "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": 17429.99, "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": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 16115.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15496.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "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": 13140.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 16115.92, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 24793.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 19215.13, "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": 19834.98, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 21074.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 10332.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12396.9, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 21376.29 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6485.69, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLERGIC REACTIONS WITHOUT MCC", "code_information": [ { "code": "916", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7427, "minimum": 5304.47, "maximum": 30928.848, "payers_information": [ { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9283.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "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": 7872.74, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 9655.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 14854.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11512.02, "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": 11883.38, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12626.09, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 5304.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12205.31 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 11839.15 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7427.11, "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": 7501.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 10397.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "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": 9655.24, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 9283.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13457.92, "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": 10843.58, "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": 10442.52, "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": 7427.11, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9655.24, "additional_payer_notes": "130.00% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 18500.87, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15262.26, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ALLGN SPEC IGE EA ARUP", "code_information": [ { "code": "86003", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7.48, "discounted_cash": 5, "minimum": 1.29, "maximum": 221.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.67, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 7.48, "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": 5.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.38 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 7.34 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.79, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.89, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 7.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.53, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.88, "additional_payer_notes": "131.74% of Medicare 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": 34708, "minimum": 25716.625, "maximum": 71033.7528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 68902.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 34708.98, "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": 35056.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 48592.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "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": 45121.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 43386.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 62892.67, "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": 50675.11, "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": 48800.83, "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": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 45121.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 43386.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "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": 36791.54, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 45121.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 69417.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 53798.92, "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": 55534.37, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 59005.27, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 34708.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 29486.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 34709, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 71033.75 } ] } ] }, { "description": "ANES ADDL 15 MIN", "code_information": [ { "code": "Z7508", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 624, "minimum": 58.47, "maximum": 624, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 70.16 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 62.56 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 } ] }, { "setting": "outpatient", "gross_charge": 624, "minimum": 58.47, "maximum": 624, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 70.16 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 62.56 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 58.47 } ] } ] }, { "description": "AMIKACIN PEAK 2.1-QUEST", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86, "discounted_cash": 15, "minimum": 9.942, "maximum": 87.4, "payers_information": [ { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.64, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ALLOGENEIC BONE MARROW TRANSPLANT", "code_information": [ { "code": "014", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 117204, "minimum": 117204, "maximum": 240794.3137, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 233570.48 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 117204.46, "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": 118376.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 164086.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "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": 152365.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 146505.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 212374.48, "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": 171118.51, "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": 164789.47, "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": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 152365.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 146505.58, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "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": 124236.24, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 152365.8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 234408.92, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 181666.91, "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": 187527.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 199247.58, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 117204.46, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 141052 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 117204, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 240794.31 } ] } ] }, { "description": "Amputation of toe", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12171.1, "discounted_cash": 4187, "minimum": 327.36, "maximum": 12171.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5350.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 392.83 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 350.28 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5444.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5527.78, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 327.36 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7119.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4834.06, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMINO ACID EACH LC", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.98, "discounted_cash": 22, "minimum": 6.894, "maximum": 22.98, "payers_information": [ { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 22.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 22.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 21.07 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 149835.59, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPUTATION TOE IP JT - 28825 - 6510812", "code_information": [ { "code": "28825", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4049.82, "discounted_cash": 4187, "minimum": 290.51, "maximum": 4049.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 4049.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 348.61 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 310.85 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 290.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID CEREBRAL BIL", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7180.6, "discounted_cash": 7121, "minimum": 256.89, "maximum": 29919.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 7180.6, "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": 7180.6, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 308.27 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "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": 7180.6, "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": 274.87 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 7180.6, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 256.89 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7180.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINOLEVULINIC ACID LC96354", "code_information": [ { "code": "82135", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 26.23, "discounted_cash": 16, "minimum": 7.869, "maximum": 26.23, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.02, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "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": 24.68, "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": 16.61, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.03, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 24.02 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 23.13 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.97 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "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": 17.44, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.71, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.5, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 26.23, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 26.23 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.79 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 16.45, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 20.56, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.67, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALPHA1-ANTITRYP TOTL PANEL-2", "code_information": [ { "code": "82103", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 67.2, "discounted_cash": 13, "minimum": 4.032, "maximum": 67.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.17, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 18.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.44 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.47, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.74, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 26.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.83, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.85, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16.8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION TOE MTP JT - 28820 - 6500821", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4049.82, "discounted_cash": 4187, "minimum": 327.36, "maximum": 12171.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 4049.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 392.83 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 350.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO ILIAC W/CCL BIL", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20028.7, "discounted_cash": 4041, "minimum": 143.37, "maximum": 20028.7, "payers_information": [ { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 172.04 } ] } ] }, { "description": "AMMONIA - 82140 - 1320316", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.62, "discounted_cash": 14, "minimum": 4.371, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.62, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 20.4, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.83 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 29.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.58, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.77, "additional_payer_notes": "170.00% 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" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 24.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.86 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.19, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9100.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANA, DIRECT", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.82, "discounted_cash": 12, "minimum": 7.5, "maximum": 69.82, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO ILIAC W/CCL UNI - 75710 - 3101276", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17340.9, "discounted_cash": 4041, "minimum": 130.84, "maximum": 20028.7, "payers_information": [ { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 157.01 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 } ] } ] }, { "description": "AMMONIA LC", "code_information": [ { "code": "82140", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.57, "discounted_cash": 14, "minimum": 4.371, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 14.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 14.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 14.57 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "170.00% 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": 14.57, "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.57 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ALUMINUM", "code_information": [ { "code": "82108", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25.48, "discounted_cash": 25, "minimum": 7.644, "maximum": 25.48, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 25.48, "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": 25.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "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": 25.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.63 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 25.48, "additional_payer_notes": "131.74% of Medicare 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6668.03, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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" } ] } ] }, { "description": "AMIKACIN TROUGH 2.1-QUEST", "code_information": [ { "code": "80150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 86, "discounted_cash": 15, "minimum": 9.942, "maximum": 87.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 30.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25.64, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.38 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15.08, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL TUMOR IHC MANUAL 1.1", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.22, "discounted_cash": 218, "minimum": 11.35, "maximum": 201.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 201.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 12.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 44.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 44.17 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO VISCERAL SEL", "code_information": [ { "code": "75726", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13129.6, "discounted_cash": 7121, "minimum": 121.45, "maximum": 13129.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 145.74 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9258.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9400.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13129.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12107.03, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMINO ACID QUAN EA LC 306266", "code_information": [ { "code": "82131", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 22.98, "discounted_cash": 22, "minimum": 6.894, "maximum": 22.98, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 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": 22.98, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 22.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.07 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.98, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOGRAPHY, INTERNAL MAMMARY", "code_information": [ { "code": "75756", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13594.2, "discounted_cash": 4041, "minimum": 143.9, "maximum": 13594.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 172.68 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 153.97 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1055.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 1055.15 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMPHETAMINES, 5 OR MORE", "code_information": [ { "code": "80326", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "AMITRIPTYLINE LC7476 - G0480 - 1701853", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 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": 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": 8, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% 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 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 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": 8, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8, "additional_payer_notes": "125.00% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY HRA DX W/COLLECTION", "code_information": [ { "code": "46601", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 468.57, "discounted_cash": 571, "minimum": 140.571, "maximum": 468.57, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "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": 468.57, "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": 468.57, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "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": 468.57, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "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": 468.57, "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": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "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": 468.57, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 468.57, "additional_payer_notes": "131.74% of Medicare 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": 42498, "minimum": 42498.69, "maximum": 84997.38, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 79950.35 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 42498.69, "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": 42923.69, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 59498.17, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "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": 55248.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 53123.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 77007.63, "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": 62048.09, "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": 59753.16, "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": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 55248.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 53123.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "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": 45048.62, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 55248.3, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 84997.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 65872.97, "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": 67997.9, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 72247.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 69273.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 42498.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 82423.05 } ] } ] }, { "description": "AMPHET/METH WHL BLD LC809360", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 64, "minimum": 3.183, "maximum": 130.74, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.38 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8566.24, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 12581.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMPHETAMINES CONF UR LC71282 - G0480 - 1715309", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 14.7, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "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": 14.7, "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": 14.7, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "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": 14.7, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.7, "additional_payer_notes": "131.74% of Medicare 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": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25639.21, "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": 19070, "minimum": 18255.2, "maximum": 38141.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 34435.33 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 19070.58, "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": 19261.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 26698.81, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "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": 24791.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 23838.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 34555.89, "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": 27843.05, "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": 26813.24, "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": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 24791.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 23838.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "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": 20214.84, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 24791.75, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 38141.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 29559.4, "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": 30512.93, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 32419.99, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.58, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18255.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 19070.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 35500.34 } ] } ] }, { "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": 48579, "minimum": 39194.375, "maximum": 97159.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 89794.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 48579.6, "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": 49065.4, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 68011.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "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": 63153.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 60724.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 88026.24, "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": 70926.22, "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": 68302.92, "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": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 63153.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 60724.5, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "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": 51494.38, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 63153.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 97159.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 75298.38, "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": 77727.36, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 82585.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 47525.3 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 48579.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 92571.77 } ] } ] }, { "description": "ANES LEVEL 3 ADDL 30M", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1155, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3248.78, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Amputation thru metatarsal", "code_information": [ { "code": "28805", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10631.25, "discounted_cash": 4187, "minimum": 605.06, "maximum": 10631.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5350.93, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 726.07 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 647.41 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5444.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5527.78, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 605.06 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7119.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 10631.3, "discounted_cash": 4187, "minimum": 605.06, "maximum": 10631.25, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5862.79, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 726.07 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 647.41 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5444.02, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5527.78, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 605.06 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8375.42, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6490.95, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7119.11, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.06 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4187.71, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5234.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5516.68, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5350.93, "additional_payer_notes": "127.78% of Medicare 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": 14371, "minimum": 14371.6, "maximum": 62962.016, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 26917.53 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 14371.61, "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": 14515.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 20120.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "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": 18683.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 17964.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26041.36, "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": 20982.55, "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": 20206.48, "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": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 18683.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17964.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "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": 15233.9, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 18683.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 28743.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22276, "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": 22994.58, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24431.74, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20127.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14371.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27750.03 } ] } ] }, { "description": "ANES LEVEL 4 ADDL 30M", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1443.75, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6022.96, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AMYLASE", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 153.62, "discounted_cash": 6, "minimum": 1.944, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9407.33, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANES LEVEL 5 1ST HR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 3465, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANTI-SCLERODERMA", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAEROBIC SENS, LC", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8.65, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 8.65, "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": 8.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 8.65, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 31219.94, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6257.77, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIBODY SCREEN/MEDIA RC", "code_information": [ { "code": "86850", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 337.11, "discounted_cash": 66, "minimum": 2.98, "maximum": 337.11, "payers_information": [ { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 93.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 97.37, "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": 93.77, "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": 3.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 86.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "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": 70.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 88.03, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 133.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 103.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 113.37, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 83.36, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 87.85, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 85.21, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.98 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "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": 100.04, "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": 67.36, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 93.37, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 66.69, "additional_payer_notes": "100.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21704.49, "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": 14699, "minimum": 14699.4, "maximum": 56939.528, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 22196.84 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 14699.44, "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": 14846.39, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 20579.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "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": 19109.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 18374.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 26635.39, "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": 21461.18, "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": 20667.41, "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": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 19109.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 18374.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "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": 15581.36, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 19109.27, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 29398.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 22784.13, "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": 23519.1, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 24989.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.44, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16597.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 14699.4, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 22883.34 } ] } ] }, { "description": "ANGIO EXT UNI", "code_information": [ { "code": "75710", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20028.7, "discounted_cash": 4041, "minimum": 130.84, "maximum": 20028.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 157.01 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 130.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS CLASS 3-5 - 80333 - 1300022", "code_information": [ { "code": "80333", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.66, "minimum": 12.498, "maximum": 41.66, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.71 } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH CC", "code_information": [ { "code": "348", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 13640, "minimum": 13640.5, "maximum": 49140.268, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19915.14, "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": 19178.56, "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": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 17732.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 17050.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "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": 14458.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 17732.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 27281.02, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 21142.79, "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": 21824.82, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 23188.87, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 16138 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 23136.97 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 22442.86 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 13640.51, "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": 13776.91, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 19096.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "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": 17732.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 13640.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 17050.64, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 13640.51, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 24716.6, "additional_payer_notes": "181.20% of Medicare Rates" } ] } ] }, { "description": "AMPUTATION TOE MTP JT - 28820 - 6510820", "code_information": [ { "code": "28820", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4049.82, "discounted_cash": 4187, "minimum": 327.36, "maximum": 12171.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 4049.82, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 392.83 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "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": 350.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "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": 4049.82, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 327.36 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4049.82, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS CLASS 3-5 - G0480 - 1300022", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 41.66, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "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": 41.66, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 41.66 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 41.66, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAL AND STOMAL PROCEDURES WITH MCC", "code_information": [ { "code": "347", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 23183, "minimum": 11970.75, "maximum": 46367, "payers_information": [ { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31549.4 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 43498.75 }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 42193.79 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 23183.5, "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": 23415.34, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 32456.9, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "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": 30138.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 28979.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 42008.5, "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": 33847.91, "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": 32596, "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": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 30138.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 28979.38, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "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": 24574.51, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 30138.55, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 46367, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 35934.43, "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": 37093.6, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 39411.95, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 23183.5, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "AMYLASE LC 102590", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 6.48, "discounted_cash": 6, "minimum": 1.944, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 6.48, "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": 6.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 6.48, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 6.48 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIOTENSIN-1 ENZYME LC", "code_information": [ { "code": "82164", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 73, "discounted_cash": 14, "minimum": 14.6, "maximum": 73, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.66, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 17.87 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.98, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 29.2, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.63, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 24.82, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 24.82 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18.25, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19.23, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS, SEROTONERGIC,", "code_information": [ { "code": "80334", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "ANAL TUMOR IHC MANUAL 1.3", "code_information": [ { "code": "88360", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 201.22, "discounted_cash": 218, "minimum": 11.35, "maximum": 201.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 201.22, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.62 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "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": 12.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "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": 201.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 44.17 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 44.17 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.35 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 201.22, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AMYLASE, BODY FLUID LC", "code_information": [ { "code": "82150", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.42, "discounted_cash": 6, "minimum": 1.944, "maximum": 153.62, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.28, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.07, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.55, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.04, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.02, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.02 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.58 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.54, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 1VW RT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505.74, "discounted_cash": 111, "minimum": 19.92, "maximum": 584.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 21.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIFUNGAL ITRACONAZOLE 183436", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 101.81, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANAEROBIC CULT EX INC LC008900", "code_information": [ { "code": "87075", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 54.69, "discounted_cash": 9, "minimum": 9.47, "maximum": 76, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "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": 14.21, "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": 9.56, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.59 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 13.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "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": 10.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.5, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 18.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.1, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 16.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.66 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 9.47, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 11.84, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.48, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2VWS BIL", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 520, "discounted_cash": 111, "minimum": 19.92, "maximum": 584.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 21.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPSYCHOTICS,NOT SPEC. 7", "code_information": [ { "code": "80344", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "ANALGESICS, 6 OR MORE", "code_information": [ { "code": "80331", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0911479", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN III ACT LC015040", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 68.43, "discounted_cash": 11, "minimum": 11.475, "maximum": 68.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0931477", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0961474", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 21609.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANES LEVEL 1 1ST HR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1000, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7339.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APPLICATION OF SHORT CAST", "code_information": [ { "code": "29405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1003.5, "discounted_cash": 357, "minimum": 122.3, "maximum": 1425.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 457.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 536.96, "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": 361.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 501.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.76 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 447.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 447.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 465.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 447.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 472.52, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 715.94, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 554.85, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 608.55, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.3 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 357.97, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 447.46, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 471.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANES LEVEL 1 ADDL 30M", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 500, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANES 1ST 60 MIN", "code_information": [ { "code": "Z7506", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18703.6, "minimum": 146.17, "maximum": 18703.56, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.4 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "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 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] }, { "setting": "outpatient", "gross_charge": 18703.56, "minimum": 146.17, "maximum": 18703.56, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 175.4 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 }, { "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 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 146.17 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 16561.94, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANES LEVEL 2 1ST HR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1732.5, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANES LEVEL 3 1ST HR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2310, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANS OCC NERVE BLOCK", "code_information": [ { "code": "64405", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 938, "discounted_cash": 392, "minimum": 90.25, "maximum": 938, "payers_information": [ { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 90.25 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 785.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 108.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 90.25 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 96.57 } ] } ] }, { "description": "ARBOVIRAL PANEL LC", "code_information": [ { "code": "86651", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50.63, "discounted_cash": 13, "minimum": 6.933, "maximum": 83.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": 19.79, "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": 13.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": 13.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANES LEVEL 2 ADDL 30M", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 866.25, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANES LEVEL 5 ADDL 30M", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1732.5, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4360.09, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ARTHROCENTESIS INTRMED JOINT", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1582.7, "discounted_cash": 392, "minimum": 54.46, "maximum": 1582.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.35 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 58.27 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 54.46 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 785.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANES LEVEL 4 1ST HR", "code_information": [ { "code": "Z7610", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2887.5, "minimum": 1, "maximum": 3465, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 } ] } ] }, { "description": "ANGINA PECTORIS", "code_information": [ { "code": "311", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7771, "minimum": 7771.39, "maximum": 41120.144, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 12448.84 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7771.39, "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": 7849.1, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 10879.95, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "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": 10102.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 9714.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 14081.76, "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": 11346.23, "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": 10926.57, "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": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 10102.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9714.24, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "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": 8237.67, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 10102.81, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 15542.78, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 12045.65, "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": 12434.22, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 13211.36, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 7928.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7771.39, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12833.86 } ] } ] }, { "description": "ANTI JO-1", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP/INJ RENAL CYST/PELVIS", "code_information": [ { "code": "50390", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2318, "discounted_cash": 906, "minimum": 101.47, "maximum": 2318, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1158.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "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": 1359.47, "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": 915.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 1268.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 121.76 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1268.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1323.21, "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": 1274.27, "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": 108.57 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "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": 960.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 1196.33, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 1812.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1404.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 101.47 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1193.93, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 3984.92, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO PELVIC SEL", "code_information": [ { "code": "75736", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12794.9, "discounted_cash": 7121, "minimum": 124.31, "maximum": 12794.9, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 149.17 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9258.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9400.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12794.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12107.03, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.31 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100, "additional_payer_notes": "127.78% of Medicare Rates" } ] } ] }, { "description": "ANTI-DNA DS", "code_information": [ { "code": "86225", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 79.35, "discounted_cash": 13, "minimum": 13.74, "maximum": 234, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "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": 20.61, "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": 13.88, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 20.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 19.32 }, { "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": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.86, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "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": 14.56, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.14, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "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": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 27.48, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.3, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.36, "additional_payer_notes": "170.00% 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": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 23.34 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.01 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.74, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 17.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18.1, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASPER GALATOMANNAN AG, LC", "code_information": [ { "code": "87305", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 119.95, "discounted_cash": 11, "minimum": 6.93, "maximum": 119.95, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.32 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.81, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.93 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10894.65, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANGIO PULMONARY BIL", "code_information": [ { "code": "75743", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 104.21, "maximum": 7478.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 125.05 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.21 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-HU LC", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 51, "discounted_cash": 12, "minimum": 3.615, "maximum": 562.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 10.59 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 9.9 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% 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": 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO CAROTID CERBRAL BIL", "code_information": [ { "code": "36223", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29919.1, "discounted_cash": 7121, "minimum": 256.89, "maximum": 29919.1, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 308.27 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 274.87 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9258.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9400.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 256.89 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14243.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12107.03, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 256.89 }, { "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" } ] } ] }, { "description": "ANGIO RENAL W/CCL BIL", "code_information": [ { "code": "36252", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 296.72, "maximum": 7478.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 356.06 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 317.49 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 296.72 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 296.72 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-NEURO NUCLEAR AB, ARUP", "code_information": [ { "code": "86255", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36, "discounted_cash": 12, "minimum": 3.615, "maximum": 562.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.88 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 10.59 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 9.9 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% 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": 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF AMPHETAMINES - 80324 - 7200105A4", "code_information": [ { "code": "80324", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.22, "minimum": 3.183, "maximum": 130.74, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 25.38 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 25.38 } ] } ] }, { "description": "ANGIO EXT BIL", "code_information": [ { "code": "75716", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 143.37, "maximum": 20028.7, "payers_information": [ { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 172.04 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 143.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANGIO RENAL W/CCL UNI", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 227.85, "maximum": 7478.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 273.42 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 243.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 227.85 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-SSB", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF AMPHETAMINES - 80353 - 7200105A5", "code_information": [ { "code": "80353", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.22, "minimum": 1.5, "maximum": 36.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 24.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 24.74 } ] } ] }, { "description": "ANGIO RENAL UNI", "code_information": [ { "code": "36251", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 7478.22, "discounted_cash": 4041, "minimum": 227.85, "maximum": 7478.22, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 273.42 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 243.8 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 227.85 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 7478.22, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 227.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO SEL EA ADDL VESSEL", "code_information": [ { "code": "75774", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1880, "minimum": 87.74, "maximum": 1880, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 105.29 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 }, { "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 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 87.74 } ] } ] }, { "description": "ANTIBIOTIC SENS DISK METH", "code_information": [ { "code": "87184", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 154, "discounted_cash": 7, "minimum": 4.85, "maximum": 154, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.56, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "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": 11.22, "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": 7.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.82 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.92 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.52 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.19 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "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": 7.93, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.87, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.59, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.72, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.48, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.85, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF BENZODIAZEPINES", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.22, "minimum": 1, "maximum": 83.5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 32.33 } ] } ] }, { "description": "ANKLE COMP 3+VWS BIL", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 776.16, "discounted_cash": 111, "minimum": 26.32, "maximum": 776.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 28.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANGIO VIA CATH", "code_information": [ { "code": "75898", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 4481.72, "discounted_cash": 4041, "minimum": 99.85, "maximum": 4481.72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 4481.72, "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": 4081.55, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 119.82 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "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": 4481.72, "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 120.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 99.85 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4481.72, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBODY ACTINOMYCES", "code_information": [ { "code": "86602", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 18.06, "discounted_cash": 10, "minimum": 3.978, "maximum": 25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.01, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 14.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.47 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13.23, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.44, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 18.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.31, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.3 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 12.73, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF ETHANOL", "code_information": [ { "code": "80320", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.22, "minimum": 3, "maximum": 36.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 28.22 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 28.22 } ] } ] }, { "description": "ANKLE COMP 3+VWS LT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.13, "discounted_cash": 111, "minimum": 26.32, "maximum": 776.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 28.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 1VW LT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 505.74, "discounted_cash": 111, "minimum": 19.92, "maximum": 584.13, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 21.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 } ] } ] }, { "description": "ANTIBOOTIC PANEL MBC", "code_information": [ { "code": "87187", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 72, "discounted_cash": 40, "minimum": 12.94, "maximum": 72, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 51.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 56.24, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.53 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 52.22, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 53.02, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 72, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 62.26, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 68.29, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 17.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.94 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 40.17, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 50.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 52.92, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASSAY OF METHADONE", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.22, "minimum": 1.5, "maximum": 36.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 26.66 } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0951475", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2VWS LT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.13, "discounted_cash": 111, "minimum": 19.92, "maximum": 584.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 21.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANT, NOT SPECIFIED", "code_information": [ { "code": "80338", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 143.75, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "description": "ASSAY OF OPIATES - 80358 - 7200105A8", "code_information": [ { "code": "80358", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.18, "minimum": 1.5, "maximum": 36.22, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 26.66 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 26.66 } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 6012512", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE 2VWS RT", "code_information": [ { "code": "73600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.13, "discounted_cash": 111, "minimum": 19.92, "maximum": 584.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 23.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 21.31 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 19.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTINUCLEAR AB LC 828421", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 25, "discounted_cash": 12, "minimum": 7.5, "maximum": 69.82, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 6672.27, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOSCOPY HRA W/ BIOPSIES", "code_information": [ { "code": "46607", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2809.17, "discounted_cash": 1531, "minimum": 842.751, "maximum": 2809.17, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1956.96, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 2144.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1914.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1991, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1914.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 2021.63, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 2809.17, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 2373.89, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2603.62, "additional_payer_notes": "170.00% of Medicare Rates" }, { "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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1531.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1914.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 2017.57, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANKLE COMP 3+VWS RT", "code_information": [ { "code": "73610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 584.13, "discounted_cash": 111, "minimum": 26.32, "maximum": 776.16, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 142.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 167.06, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 112.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 155.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 162.6, "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": 156.59, "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": 28.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 144.78, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "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": 118.05, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 147.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 222.74, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 172.62, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 189.33, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 71.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 26.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 111.37, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 139.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 146.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIPEDRESSANTS, TRICYCLIC, 7", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5, "minimum": 1.5, "maximum": 41.66, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 10738.81, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0901470", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" } ] } ] }, { "description": "ANTIPSYCHOTICS - 80342 - 7100100A16", "code_information": [ { "code": "80342", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "minimum": 3, "maximum": 100.53, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 } ] } ] }, { "description": "ATHERECTOMY BRACHIOCEPHA PERC", "code_information": [ { "code": "0237T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 35791.4, "discounted_cash": 14775, "minimum": 4132, "maximum": 35791.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 18879.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22162.5, "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": 14922.75, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 20685, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20685, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18468.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 18468.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21571.5, "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": 20773.65, "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": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19207.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 18468.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 15661.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 19503, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 29550, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 22901.25, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 25117.5, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 14775, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 18468.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 19463.85, "additional_payer_notes": "131.74% 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13254.22, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0921478", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN 0 SCREEN", "code_information": [ { "code": "86063", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38, "discounted_cash": 5, "minimum": 5.77, "maximum": 38, "payers_information": [ { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 11.54, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.94, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.81, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.82 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.6, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.37, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.07 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.77, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 7.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.21, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.89 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.62, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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" } ] } ] }, { "description": "ATHEROSCLEROSIS WITHOUT MCC", "code_information": [ { "code": "303", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 7493, "minimum": 6256.8, "maximum": 31074.776, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 11987.12 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 7493.84, "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": 7568.78, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 10491.38, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "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": 9741.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 9367.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 13578.84, "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": 10941.01, "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": 10536.34, "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": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 9741.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 9367.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 7943.47, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 9741.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 14987.68, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 11615.45, "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": 11990.14, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 12739.53, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 6256.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 7493.84, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 12357.85 } ] } ] }, { "description": "ANTI CHROMATIN", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0941476", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN III AG LC 015057", "code_information": [ { "code": "85301", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 62.43, "discounted_cash": 10, "minimum": 10.81, "maximum": 62.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.81, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.24 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 21.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.38, "additional_payer_notes": "170.00% 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" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 18.37 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.03 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 13.51, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.24, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI DNASE B STREP LC", "code_information": [ { "code": "86215", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.77, "discounted_cash": 13, "minimum": 4.731, "maximum": 15.77, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 15.77, "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": 13.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 13.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 15.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.25, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.77, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY DX W/WO COL SPEC - 46600 - 0971473", "code_information": [ { "code": "46600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 315.12, "discounted_cash": 170, "minimum": 31.51, "maximum": 315.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 37.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 33.72 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 31.51 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 315.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 31.51 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTITHROMBIN III AG LC 2", "code_information": [ { "code": "82310", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5.16, "discounted_cash": 5, "minimum": 1.548, "maximum": 87.78, "payers_information": [ { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 5.16, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 5.16 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.7 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 5.16, "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": 5.16, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5.16, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTI FUNGAL SUSC EA LC", "code_information": [ { "code": "87188", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 90, "discounted_cash": 6, "minimum": 6.64, "maximum": 180, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.48, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "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": 9.96, "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": 6.71, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.12 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.3, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.69 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 9.34 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.63, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "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": 7.04, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8.76, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.29, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.28 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.77 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 6.64, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8.3, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.75, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANOSCOPY RMVL FB", "code_information": [ { "code": "46608", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 5254.1, "discounted_cash": 1190, "minimum": 154.87, "maximum": 5254.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1520.83, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 1666.31, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 185.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1487.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1487.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1547.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1487.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 1571.09, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 2380.44, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1844.84, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 2023.37, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 154.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 1190.22, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1487.78, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1567.94, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI RI ANTIBODIES", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 29.45, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 4225.56, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC", "code_information": [ { "code": "269", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 41824, "minimum": 6750, "maximum": 104048.636, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 74174.29 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 41824.65, "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": 42242.95, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 58554.51, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "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": 54372.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 52280.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 75786.27, "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": 61063.99, "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": 58805.46, "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": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 54372.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 52280.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "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": 44334.18, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 54372.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 83649.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 64828.21, "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": 66919.44, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 71101.91, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 8237.12 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 41824.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 76468.34 } ] } ] }, { "description": "AU OAE LTD IPSCR - 92587 - 0201095", "code_information": [ { "code": "92587", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.49, "discounted_cash": 276, "minimum": 49.99, "maximum": 746.49, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 353.11, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 386.89, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 59.99 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 53.49 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 359.26, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 364.78, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 49.99 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 552.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 428.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 469.8, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 49.99 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 276.35, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 345.44, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 364.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI- RNA", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 13219.02, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AORTO ABD W/SERIAL", "code_information": [ { "code": "75625", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 17340.9, "discounted_cash": 4041, "minimum": 102.25, "maximum": 17340.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 122.7 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 102.25 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AU OAE LTD RESCR - Z9727 - 0201111", "code_information": [ { "code": "Z9727", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 746.49, "minimum": 43.03, "maximum": 746.49, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 51.64 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.04 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 43.03 } ] } ] }, { "description": "ANTI-GBM IGA LC806435", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 59.45, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 2268.08, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "APOLIPOPROTEIN EA ARUP 99174", "code_information": [ { "code": "82172", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 21.09, "discounted_cash": 21, "minimum": 6.327, "maximum": 21.09, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 21.09, "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": 21.09, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.11 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": 21.09, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 21.09 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 15.09 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 21.09, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AUD SPCH AUDIOMETRY THRSHLD", "code_information": [ { "code": "0210T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.25, "discounted_cash": 47, "minimum": 30.975, "maximum": 103.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.08, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-SMITH", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI MULLERIAN HORMONE LC", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 77, "discounted_cash": 11, "minimum": 3.459, "maximum": 302, "payers_information": [ { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "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": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "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": 17.3, "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": 11.65, "additional_payer_notes": "101.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 8727.8, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "AUD SPEECH AUDIOMETRY AUTO REC", "code_information": [ { "code": "0211T", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.25, "discounted_cash": 47, "minimum": 30.975, "maximum": 103.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 66.91, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group 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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.13, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.08, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 95.58, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.07, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.24, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.79, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 59.74, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 62.96, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-SSA", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI MYOCARDIAL ABS LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12.05, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 11244.48, "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 42705.07, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIBIOTIC SENS AGAR DIL", "code_information": [ { "code": "87181", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 27, "discounted_cash": 4, "minimum": 1.33, "maximum": 190.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.6 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.33 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-CENTROMERE", "code_information": [ { "code": "86235", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 103.55, "discounted_cash": 17, "minimum": 5.379, "maximum": 103.55, "payers_information": [ { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 30.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 23.62, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22.91, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 25.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 20.09 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 17.91 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 23.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.74 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 23.67, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 16.74 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 35.86, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 27.79, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 17.93, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 30.48, "additional_payer_notes": "170.00% of Medicare 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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 7065.57, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "Av fusion direct any site", "code_information": [ { "code": "36821", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16359.4, "discounted_cash": 4041, "minimum": 623.2, "maximum": 16359.4, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 747.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 666.82 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 623.2 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 623.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBIOTIC SENS MIC", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 346.5, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 } ] } ] }, { "description": "ANTI-CMV NEG RC", "code_information": [ { "code": "86870", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 646.29, "discounted_cash": 458, "minimum": 18.96, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 586.19, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 646.29, "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": 463.35, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 642.26, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 22.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 646.29, "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 596.39, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 605.56, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 646.29, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 646.29, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 646.29, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 29.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.96 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 458.76, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 573.45, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 604.35, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH CC", "code_information": [ { "code": "398", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15621, "minimum": 13500, "maximum": 31407.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 26976.36 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 15621.06, "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": 15777.31, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 21869.48, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "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": 20307.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 19526.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 28305.36, "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": 22806.75, "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": 21963.21, "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": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 20307.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19526.33, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "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": 16558.37, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 20307.38, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 31242.12, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 24212.64, "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": 24993.7, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26555.8, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.06, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 31407.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15621.1, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 27810.68 } ] } ] }, { "description": "BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CCMCC", "code_information": [ { "code": "520", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 15430, "minimum": 9000, "maximum": 56600.344, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 25550.17 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 15430.54, "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": 15584.81, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 21602.76, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "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": 20059.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 19288.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 27960.14, "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": 22528.59, "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": 21695.34, "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": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 20059.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 19288.18, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "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": 16356.33, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 20059.7, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 30861.08, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 23917.34, "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": 24688.86, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 26231.92, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.54, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20966.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 15430.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 26340.38 } ] } ] }, { "description": "ANTIBIOTIC SENSITIVITY EA", "code_information": [ { "code": "87190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.55, "discounted_cash": 7, "minimum": 5.23, "maximum": 84, "payers_information": [ { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "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": 7.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "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": 10.97, "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": 7.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.28 } ] } ] }, { "description": "ANTI-HU LC808988", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.48, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 25716.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIBODY TITER,EACH RC", "code_information": [ { "code": "86886", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 218, "minimum": 4.84, "maximum": 80, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.81 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "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": 80, "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": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "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": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "170.00% 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": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 4.84 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-MYOCARDIAL ABS LC", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 15.71, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 15.71, "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": 12.17, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.71 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 15.71 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 15.71 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 15.71 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARBOVIRAL M PANEL LC", "code_information": [ { "code": "86652", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 37.58, "discounted_cash": 13, "minimum": 3.957, "maximum": 83.13, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 16.85, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": 19.79, "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": 13.32, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 18.47, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 19.26 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 18.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.39 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 17.15, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "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": 13.98, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.41, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 26.38, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 20.44, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 22.42, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 22.42 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 13.19, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 16.49, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 17.38, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIFUNGAL MICAFUNGIN 183509", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 50, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-NEUTRO. CYTOPLASM", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.59, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "ANTIGEN SCREEN/UNIT, VIA REAGE", "code_information": [ { "code": "86902", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 458, "minimum": 2.62, "maximum": 2179.12, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 3.14 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "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": 80, "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": 2.8 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 6.5 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 2.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 80, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTI-RI LC808978", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 36.48, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL BLOOD DRAW", "code_information": [ { "code": "82803", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 200, "discounted_cash": 26, "minimum": 13.6, "maximum": 200, "payers_information": [ { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 32.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 38.06 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 36.65 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.55 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 33.89, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "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": 27.63, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 34.41, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 52.14, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 40.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 44.32, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 32.59, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 34.34, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 33.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 13.6 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "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": 39.11, "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": 26.33, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 36.5, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 26.07, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 16.32 } ] } ] }, { "description": "BARBITURATES LC", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 16.3, "minimum": 1, "maximum": 16.3, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 16.3 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 16.3 } ] } ] }, { "description": "ANTIPSYCHOTICS - G0480 - 7100100A16", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_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, "additional_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, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "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": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBIOTIC SENS", "code_information": [ { "code": "87190", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 84, "discounted_cash": 7, "minimum": 5.23, "maximum": 84, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.34, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "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": 10.97, "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": 7.38, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 6.28 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10.23, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.67 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10.28 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.6 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "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": 7.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.65, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.62, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.33, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.43, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 9.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 5.23 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.14, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.63, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTERIAL PUNCTURE", "code_information": [ { "code": "36600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 874.34, "discounted_cash": 170, "minimum": 18.16, "maximum": 874.34, "payers_information": [ { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 19.43 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 221.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 224.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 18.16 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 340.56, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 263.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 289.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 212.85, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 224.32, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 217.58, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 238.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 21.79 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 170.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 18.16 }, { "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" } ] } ] }, { "description": "BARBITURATES LC 2 P X 5", "code_information": [ { "code": "80345", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1.55, "minimum": 1, "maximum": 16.3, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 1.55 } ] } ] }, { "description": "ANTITHROMBIN III ACTIVITY", "code_information": [ { "code": "85300", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 38.25, "discounted_cash": 11, "minimum": 11.475, "maximum": 68.43, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.14, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.59, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.41 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.64, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.7, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.37, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.15, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.15 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.01 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.85, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.61, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBIOTIC SENS ENZ METH", "code_information": [ { "code": "87185", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 31.19, "discounted_cash": 4, "minimum": 1, "maximum": 31.19, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.07, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 6.65, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1.16 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6.18, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 6.27, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 9.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 7.36, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8.08, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 8.08 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4.75, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 6.26, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTHERECTOMY/PTA TIB/PERONEAL", "code_information": [ { "code": "37229", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 99992.5, "discounted_cash": 22494, "minimum": 6490, "maximum": 99992.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 28743.36, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "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": 33742.41, "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": 22719.89, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 31492.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "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": 31492.92, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28118.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 28118.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 32842.61, "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": 31627.89, "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": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 29243.42, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 28118.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "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": 23844.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 29693.32, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 44989.88, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 34867.16, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 38241.4, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 22494.94, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 28118.68, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 29633.71, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "BARTONELLA AB 1.1", "code_information": [ { "code": "86611", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 11.1, "discounted_cash": 10, "minimum": 3.33, "maximum": 58.79, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": 11.1, "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": 10.28, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.69 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 11.1 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.24 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10.18, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.1, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIBIOTIC SENS MIC 1.1", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ARTHRO ANKLE", "code_information": [ { "code": "73615", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 2144.67, "discounted_cash": 446, "minimum": 79.92, "maximum": 2144.67, "payers_information": [ { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 589.38, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 893, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 692.08, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 759.05, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 448.93 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 448.93 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 558.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 588.2, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 570.52, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 625.1, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 95.9 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 446.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 558.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 580.45, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 558.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 79.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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" } ] } ] }, { "description": "BEHAV CHNG SMOKING 3-10", "code_information": [ { "code": "99406", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 199.55, "discounted_cash": 47, "minimum": 10.41, "maximum": 199.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 61.27, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 12.94, "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": 71.93, "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": 48.43, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 67.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.49 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 67.13, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 70.01, "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": 67.42, "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": 11.14 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 62.34, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "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": 50.83, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 63.29, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 95.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 74.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 81.52, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.41 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 47.95, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 59.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 63.17, "additional_payer_notes": "131.74% of Medicare 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": 67497, "minimum": 18120.7, "maximum": 134994.64, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 118865.69 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 67497.32, "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": 68172.27, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 94496.25, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "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": 87746.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 84371.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 122305.14, "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": 98546.09, "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": 94901.23, "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": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 87746.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 84371.65, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "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": 71547.14, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 87746.52, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 134994.64, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 104620.85, "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": 107995.71, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 114745.44, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.32, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 18120.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 67497.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 122541.95 } ] } ] }, { "description": "ANTIBIOTIC SENS MIC 16.1", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 78, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP ABSCESS/BULLA/CYST - 10160 - 6510713", "code_information": [ { "code": "10160", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 932.4, "discounted_cash": 520, "minimum": 67.29, "maximum": 2171.68, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 664.8, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "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": 780.42, "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": 525.48, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 728.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 80.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 728.39, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 650.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 759.61, "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": 731.51, "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": 72 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 676.36, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 650.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "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": 551.5, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 686.77, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 932.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 806.43, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 884.48, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 67.29 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 520.28, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 650.35, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 685.39, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "AORTO THOR W/SERIAL", "code_information": [ { "code": "75605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 12794.9, "discounted_cash": 7121, "minimum": 98.32, "maximum": 12794.9, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9100, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 9970.49, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 117.98 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9258.31, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9400.75, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 12794.9, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11038.76, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12107.03, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 98.32 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7121.78, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8902.23, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9381.88, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTIDEPRESSANTS,TRICYCLICS, 6+ - 80337 - 7100100A17", "code_information": [ { "code": "80337", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "minimum": 1.5, "maximum": 41.66, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 } ] } ] }, { "description": "ASP CYST BRST EA ADDL BIL", "code_information": [ { "code": "19001", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 562, "minimum": 29.91, "maximum": 562, "payers_information": [ { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 35.89 }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 32 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 29.91 } ] } ] }, { "description": "BENZODIAZEPINES 1.3 - 80346 - 1705714", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 33.95, "minimum": 1, "maximum": 83.5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 32.33 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 32.33 } ] } ] }, { "description": "Appendectomy", "code_information": [ { "code": "44950", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 13087.5, "discounted_cash": 8285, "minimum": 574.61, "maximum": 13087.5, "payers_information": [ { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10357.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10915.05, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10587.1, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "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": 12428.42, "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": 8368.47, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 11599.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 689.53 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11599.85, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10357.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10357.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 12096.99, "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": 11649.57, "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": 614.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10771.29, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10357.01, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "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": 8782.75, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10937.01, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 13087.5, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 12842.7, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8285.61, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 13087.5, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 574.61 } ] } ] }, { "description": "ANTIDEPRESSANTS,TRICYCLICS, 6+ - G0480 - 7100100A17", "code_information": [ { "code": "G0480", "type": "HCPCS" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 10, "discounted_cash": 114, "minimum": 1, "maximum": 904.31, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_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, "additional_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, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "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": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% 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, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 10, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP CYST BRST LT", "code_information": [ { "code": "19000", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1718.55, "discounted_cash": 906, "minimum": 50.2, "maximum": 1718.55, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1158.06, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "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": 1359.47, "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": 915.37, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 1268.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 60.24 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1268.83, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1323.21, "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": 1274.27, "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": 53.71 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1178.2, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "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": 960.69, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 1196.33, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 1718.55, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 1404.78, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 1540.73, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 50.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 906.31, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 1132.89, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 1193.93, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "BENZODIAZEPINES LC 700617 - 80346 - 1700046", "code_information": [ { "code": "80346", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1.55, "minimum": 1, "maximum": 83.5, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 1.55 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 1.55 } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 15997.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIFUNGAL POSACONAZOLE 183517", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 80, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP/INJ INT JT - 20605 - 6011704", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 54.46, "maximum": 1582.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.35 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 58.27 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 54.46 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "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": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% 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" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "case rate", "standard_charge_dollar": 9012.97, "additional_payer_notes": "100% of State Medicaid Rates" } ] } ] }, { "description": "ANTIFUNGAL VORICONAZOLE 183525", "code_information": [ { "code": "87186", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 65.16, "discounted_cash": 8, "minimum": 2.595, "maximum": 346.5, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.05, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 12.11, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.34 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 11.25, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.42, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 17.3, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 13.41, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.71, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 14.7 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.62 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8.65, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 10.81, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.4, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP/INJ INT JT - 20605 - 6510887", "code_information": [ { "code": "20605", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 54.46, "maximum": 1582.7, "payers_information": [ { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 54.46 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.35 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 54.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 58.27 }, { "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" } ] } ] }, { "description": "BETA-D-GLUCAN,LC832599", "code_information": [ { "code": "87449", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 34.65, "discounted_cash": 11, "minimum": 9.64, "maximum": 110, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.31, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.77, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.57 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.57, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.81, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.96, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.57, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.37, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.39 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.64 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.98, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.98, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.78, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITH MCC", "code_information": [ { "code": "397", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 24143, "minimum": 22950, "maximum": 48287.6, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 44172.63 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 24143.8, "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": 24385.24, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 33801.32, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "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": 31386.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 30179.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 43748.57, "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": 35249.95, "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": 33946.18, "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": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 31386.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 30179.75, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "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": 25592.43, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 31386.94, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 48287.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 37422.89, "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": 38630.08, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 41044.46, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 34928.8 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 24143.8, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 45538.79 } ] } ] }, { "description": "ANTINUCLEAR ANTIBODIES, IFA", "code_information": [ { "code": "86038", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 69.82, "discounted_cash": 12, "minimum": 7.5, "maximum": 69.82, "payers_information": [ { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.93, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.45, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.93, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.64 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.11, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.2 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.96, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.18, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.74, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.09, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.55, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.54 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.54 } ] } ] }, { "description": "ASP/INJ MJR JT - 20610 - 6500896", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 65.68, "maximum": 1582.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.82 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPENDIX PROCEDURES WITHOUT CCMCC", "code_information": [ { "code": "399", "type": "MS-DRG" } ], "standard_charges": [ { "setting": "inpatient", "discounted_cash": 12053, "minimum": 8550, "maximum": 24107.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "case rate", "standard_charge_dollar": 20034.39 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "case rate", "standard_charge_dollar": 12053.55, "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": 12174.04, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "case rate", "standard_charge_dollar": 16874.97, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "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": 15669.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "case rate", "standard_charge_dollar": 15066.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial", "methodology": "case rate", "standard_charge_dollar": 21841.03, "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": 17598.18, "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": 16947.29, "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": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "case rate", "standard_charge_dollar": 15669.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "case rate", "standard_charge_dollar": 15066.94, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "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": 12776.71, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "case rate", "standard_charge_dollar": 15669.62, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "case rate", "standard_charge_dollar": 24107.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "case rate", "standard_charge_dollar": 18683, "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": 19285.68, "additional_payer_notes": "160.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "case rate", "standard_charge_dollar": 20491.04, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.55, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "case rate", "standard_charge_dollar": 20201.9 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "case rate", "standard_charge_dollar": 12053.5, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "case rate", "standard_charge_dollar": 20654.01 } ] } ] }, { "description": "ANTIPROTEINASE(PR3)AB LC163067", "code_information": [ { "code": "83516", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 40.43, "discounted_cash": 11, "minimum": 3.459, "maximum": 302, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 14.73, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "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": 17.3, "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": 11.65, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.84 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 16.14, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 16.83 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial PPO", "methodology": "fee schedule", "standard_charge_dollar": 16.21 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 10.56 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 14.99, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "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": 12.22, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.22, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 23.06, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 17.87, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 19.6, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 19.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 9.87 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 11.53, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 14.41, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.19, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP/INJ MJR JT - 20610 - 6510895", "code_information": [ { "code": "20610", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 65.68, "maximum": 1582.7, "payers_information": [ { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 65.68 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 78.82 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" } ] } ] }, { "description": "BI MAL ANKLE FX W/POTTS W/O MN", "code_information": [ { "code": "27808", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 1036.2, "discounted_cash": 315, "minimum": 310.86, "maximum": 1036.2, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 403.39, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 473.55, "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": 318.86, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 605.58 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 441.98, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 460.92, "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": 443.87, "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": 539.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 410.41, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "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": 334.64, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 416.72, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 631.4, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 489.34, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 536.69, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 504.65 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 315.7, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 394.63, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 415.89, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "APPL MLTPLN UNI EXT FIXJ SYS", "code_information": [ { "code": "20692", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 8725, "discounted_cash": 16431, "minimum": 381.29, "maximum": 8725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 457.55 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "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": 8725, "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": 407.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "131.74% of Medicare Rates" } ] }, { "setting": "outpatient", "gross_charge": 8725, "discounted_cash": 16431, "minimum": 381.29, "maximum": 8725, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, VA", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "150.00% of Medicare Rates" }, { "payer_name": "Brand New Day", "plan_name": "Brand New Day Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "101.00% of Medicare Rates" }, { "payer_name": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 457.55 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Employer Direct Healthcare", "plan_name": "Employer Direct Healthcare Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Cal Mediconnect", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "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": 8725, "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": 407.98 }, { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Imperial Health Plan Of CA", "plan_name": "Imperial Health Plan Of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "106.00% of Medicare Rates" }, { "payer_name": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Exchange", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Molina", "plan_name": "Molina Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Molina", "plan_name": "Molina Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "Traditional Medicare", "plan_name": "Traditional Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Tricare", "plan_name": "Tricare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 381.29 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 8725, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ANTISTREPTOLYSIN 0 TITER", "code_information": [ { "code": "86060", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 133, "discounted_cash": 7, "minimum": 7.3, "maximum": 133, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.33, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 10.22, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 8.94 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 9.49, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 9.64, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 14.6, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 11.32, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 12.41, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 12.41 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 7.45 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 7.3, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 9.13, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 9.62, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "ASP/INJ SM JT", "code_information": [ { "code": "20600", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 734.1, "discounted_cash": 392, "minimum": 46.46, "maximum": 1481.1, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 501.98, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 550, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 55.75 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": 49.71 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 510.72, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 518.58, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 46.46 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 734.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 608.93, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 667.86, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "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": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 46.46 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 392.86, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 491.08, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 517.53, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Aquaporin 4 AB Titer,LC505298", "code_information": [ { "code": "86256", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 100, "discounted_cash": 12, "minimum": 3.615, "maximum": 100, "payers_information": [ { "payer_name": "Health Net Of CA", "plan_name": "Health Net Of CA Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.75 }, { "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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 15.67, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.91, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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": 11.92 }, { "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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 24.1, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 18.68, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 20.49, "additional_payer_notes": "170.00% of Medicare Rates" }, { "payer_name": "Traditional Medi-Cal", "plan_name": "Traditional Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 20.48 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.87, "additional_payer_notes": "131.74% of Medicare Rates" }, { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.3 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 11.92 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 15.06, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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 } ] } ] }, { "description": "AORTO ABD BIL IF LOW EXT - 75630 - 3191012", "code_information": [ { "code": "75630", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 20028.7, "discounted_cash": 4041, "minimum": 104.04, "maximum": 20028.7, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5163.65, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 5657.6, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 124.85 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "COUNTY OF SAN DIEGO", "plan_name": "COUNTY OF SAN DIEGO County Medical Services (CMS)", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "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": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Commercial And Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Golden Physicians Medical Group", "plan_name": "Golden Physicians Medical Group Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Health Excel Ins", "plan_name": "Health Excel Ins Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Health Net Federal Service (CDCR)", "plan_name": "CDCR Prison", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "HEALTH NET FEDERAL SERVICES TRICARE", "plan_name": "Health Net Federal Services Tricare", "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 Cal Mediconnect", "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 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": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial", "methodology": "fee schedule", "standard_charge_dollar": 5253.48, "additional_payer_notes": "130.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Commercial Ins Exchange", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "Heritage Provider Netwrok", "plan_name": "Heritage Provider Network Medicare", "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": "Integrated Medical Solutions", "plan_name": "Integrated Medical Solutions Prison", "methodology": "fee schedule", "standard_charge_dollar": 5334.3, "additional_payer_notes": "132.00% of Medicare Rates" }, { "payer_name": "Managed Health Network", "plan_name": "Managed Health Network 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 Inmates", "methodology": "fee schedule", "standard_charge_dollar": 8082.28, "additional_payer_notes": "200.00% of Medicare Rates" }, { "payer_name": "Naphcare", "plan_name": "Naphcare Prison", "methodology": "fee schedule", "standard_charge_dollar": 6263.77, "additional_payer_notes": "155.00% of Medicare Rates" }, { "payer_name": "Renal Payer Solutions", "plan_name": "Renal Payor Solutions Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Scripps Health", "plan_name": "Scripps Health Commercial", "methodology": "fee schedule", "standard_charge_dollar": 6869.94, "additional_payer_notes": "170.00% 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": "United Healthcare", "plan_name": "UHC Commercial All Payor", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "UHC Commercial Select Navigate Core", "methodology": "fee schedule", "standard_charge_dollar": 3338.61 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 104.04 }, { "payer_name": "United Healthcare", "plan_name": "United Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "USA Senior Care Network", "plan_name": "USA Senior Health Care Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Verda Health Plan", "plan_name": "Verda Health Plan Medicare", "methodology": "fee schedule", "standard_charge_dollar": 4041.14, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "VETERANS EVALUATION SERVICES", "plan_name": "Veterans Evaluation Services", "methodology": "fee schedule", "standard_charge_dollar": 5051.43, "additional_payer_notes": "125.00% of Medicare Rates" }, { "payer_name": "Worker Comp", "plan_name": "Worker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 5323.6, "additional_payer_notes": "131.74% of Medicare Rates" } ] } ] }, { "description": "Aquaporin 4 AB, LC505295", "code_information": [ { "code": "86052", "type": "CPT" } ], "standard_charges": [ { "setting": "outpatient", "gross_charge": 439.25, "discounted_cash": 12, "minimum": 12.05, "maximum": 439.25, "payers_information": [ { "payer_name": "Aetna", "plan_name": "Coventry Woker Compensation", "methodology": "fee schedule", "standard_charge_dollar": 15.4, "additional_payer_notes": "127.78% of Medicare Rates" }, { "payer_name": "Aetna Better Health Medi-Cal", "plan_name": "Aetna Better Health Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "Blue Sheid Of Promise", "plan_name": "Blue Shield Of Promise Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 12.05 }, { "payer_name": "BLUE SHIELD OF CA, VA", "plan_name": "Blue Shield Of CA, 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": "CA DEPT OF CORRECTION & REHAB", "plan_name": "CA Dept Of Correction & Rehab", "methodology": "fee schedule", "standard_charge_dollar": 16.87, "additional_payer_notes": "140.00% of Medicare Rates" }, { "payer_name": "CA FOUNDATION FOR MEDICAL CARE", "plan_name": "CA Foundation for Medical Care Workers Compensation", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Central Health", "plan_name": "Central Health Plan of CA Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Choice Physicians Network", "plan_name": "Choice Physicians Network Medicare", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Clever Care of Golden State, Inc", "plan_name": "Clever Care Of Golden State", "methodology": "fee schedule", "standard_charge_dollar": 12.05, "additional_payer_notes": "100.00% of Medicare Rates" }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medi-Cal", "methodology": "fee schedule", "standard_charge_dollar": 14.46 }, { "payer_name": "Community Health Group", "plan_name": "Community Health Group Medicare", "methodology": "fee schedule",